RYAN DIEDERICH

FORT WAYNE, IN
NPI1104236108
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: IN  06004770A)
Enumeration Date2014-04-30
Last Update Date2014-04-30
Business Address
-- RYAN DIEDERICH
2827 NORTHGATE BLVD
FORT WAYNE, IN 46835-2900
Phone number: 260-490-1400
Mailing Address
-- RYAN DIEDERICH
302 UNION STATION DR
FORT WAYNE, IN 46814-8964
Phone number:
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