Provider Demographics
NPI:1811195688
Name:DIFFENDERFER, SUSAN G (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:DIFFENDERFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:THOMPSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17094
Mailing Address - Country:US
Mailing Address - Phone:717-535-4023
Mailing Address - Fax:
Practice Address - Street 1:102 CHANDRA DR
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-9745
Practice Address - Country:US
Practice Address - Phone:717-834-4111
Practice Address - Fax:717-834-6332
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002548E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist