Provider Demographics
NPI:1144637562
Name:DEFREES, TODD
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:DEFREES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HAUSMAN RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9393
Mailing Address - Country:US
Mailing Address - Phone:610-841-0071
Mailing Address - Fax:610-841-0072
Practice Address - Street 1:800 HAUSMAN RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9393
Practice Address - Country:US
Practice Address - Phone:610-841-0071
Practice Address - Fax:610-841-0072
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009622225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant