Provider Demographics
NPI:1740882463
Name:DIFFENDERFFER, ERIN (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DIFFENDERFFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:CORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4377 DUNMORE RD NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4222
Mailing Address - Country:US
Mailing Address - Phone:678-595-8662
Mailing Address - Fax:
Practice Address - Street 1:4377 DUNMORE RD NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4222
Practice Address - Country:US
Practice Address - Phone:678-595-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist