Provider Demographics
NPI:1083171318
Name:O'FLAHERTY, KYLE (PT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:O'FLAHERTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 MARTIS PL
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1318
Mailing Address - Country:US
Mailing Address - Phone:551-427-7941
Mailing Address - Fax:212-223-0198
Practice Address - Street 1:282 MARTIS PL
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1318
Practice Address - Country:US
Practice Address - Phone:551-427-7941
Practice Address - Fax:212-223-0198
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0438702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043870OtherNY STATE