=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275497091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLY DIEM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2025
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 MANOR DR
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-3118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-874-0306
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 S VINE ST
-----------------------------------------------------
City | DESHLER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43516-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-301-2011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------