Individual
TODD DIEFENDERFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
404 N MAIN ST, ENTERPRISE, AL 36330-2563
(334) 308-9797
(334) 836-2247
Mailing address
PO BOX 729, DOTHAN, AL 36302-0729
(334) 793-2663
(334) 836-2247
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA3762
AL
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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