Provider Demographics
NPI:1700545217
Name:STIFFLER, NATHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:STIFFLER
Suffix:
Gender:M
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 1:588 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021-2012
Mailing Address - Country:US
Mailing Address - Phone:724-809-4168
Mailing Address - Fax:
Practice Address - Street 1:105 SUNRISE CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8246
Practice Address - Country:US
Practice Address - Phone:615-649-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist