Basic Information
| Provider Information | |||||||||
| NPI: | 1811195688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIFFENDERFER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 W. MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | THOMPSONTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175354023 | ||||||||
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| Practice Location | |||||||||
| Address1: | 102 CHANDRA DR | ||||||||
| Address2: | |||||||||
| City: | DUNCANNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170209745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178344111 | ||||||||
| FaxNumber: | 7178346332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT002548E | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.