Healthcare Provider Details

I. General information

NPI: 1760925846
Provider Name (Legal Business Name): STEPHANIE ANNE DIFURIA PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 KING OF PRUSSIA RD
RADNOR PA
19087-5227
US

IV. Provider business mailing address

250 KING OF PRUSSIA RD
RADNOR PA
19087-5227
US

V. Phone/Fax

Practice location:
  • Phone: 610-902-2300
  • Fax:
Mailing address:
  • Phone: 610-902-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02063800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT030099
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: