Provider Demographics
NPI:1164738118
Name:DIFFENBAUGH, NATHAN A (MSPT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:A
Last Name:DIFFENBAUGH
Suffix:
Gender:M
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 LUELLA DR
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-1230
Mailing Address - Country:US
Mailing Address - Phone:717-503-3193
Mailing Address - Fax:
Practice Address - Street 1:2901 EMRICK BLVD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8062
Practice Address - Country:US
Practice Address - Phone:610-625-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist