Healthcare Provider Details

I. General information

NPI: 1275497091
Provider Name (Legal Business Name): ALLY DIEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLY DECKER

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MANOR DR
PERRYSBURG OH
43551-3118
US

IV. Provider business mailing address

311 S VINE ST
DESHLER OH
43516-1419
US

V. Phone/Fax

Practice location:
  • Phone: 419-874-0306
  • Fax:
Mailing address:
  • Phone: 937-301-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: