Provider Demographics
NPI:1942588496
Name:DIFFIE, PAULA BETH (PT,DPT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:BETH
Last Name:DIFFIE
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N ALLEGHANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4408
Mailing Address - Country:US
Mailing Address - Phone:432-332-8244
Mailing Address - Fax:432-580-7428
Practice Address - Street 1:620 N ALLEGHANEY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4408
Practice Address - Country:US
Practice Address - Phone:432-332-8244
Practice Address - Fax:432-580-7428
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1208772OtherPHYSICAL THERAPY LICENSE