Individual
MRS. LISA MARIE DIFFENBAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
204 CAMERON DR, DOUGLASSVILLE, PA 19518-8720
(484) 529-9663
(484) 991-2109
Mailing address
322 LUELLA DR, KUTZTOWN, PA 19530-1230
(570) 594-4015
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT016899
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101209274
MA
PA
Enumeration date
12/27/2006
Last updated
05/23/2014
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