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Individual
LISA DIEFENBACH
Active
Individual
LISA DIEFENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT002640E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1536333
GATEWAY HEALTH PLANS
PA
01
—
624203
HIGHMARK
PA
Enumeration date
12/14/2006
Last updated
07/08/2007
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