Provider Demographics
NPI:1679927289
Name:STROFFOLINO, DIANA LYN (MPT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYN
Last Name:STROFFOLINO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2010 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2744
Mailing Address - Country:US
Mailing Address - Phone:610-853-0508
Mailing Address - Fax:610-853-3837
Practice Address - Street 1:2010 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 450
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2744
Practice Address - Country:US
Practice Address - Phone:610-853-0508
Practice Address - Fax:610-853-3837
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT015001OtherPHYSICAL THERAPY LICENSE