Doctor Name: | MRS. LISA MARIE DIFFENBAUGH |
NPI Number: | 1205991585 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSPT |
License Number: | PT016899 |
Business Practice Address: | 204 Cameron Dr Douglassville, PA - 195188720 |
Business Phone Number: | 4845299663 |
Business Fax Number: | 4849912109 |
Mailing Address: | 322 Luella Dr, KUTZTOWN |
State: | PA |
Postal Code: | 195301230 |
Phone Number: | 5705944015 |
Fax Number: | |
NPI Enumeration Date: | 12/27/2006 |
NPI Last Update Date: | 05/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | PT016899 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |