Provider Demographics
NPI:1114312543
Name:GAFFNEY, KELSEY QUINN (DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:QUINN
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 ARIZONA ST
Mailing Address - Street 2:APT 17
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1701
Mailing Address - Country:US
Mailing Address - Phone:440-308-4557
Mailing Address - Fax:
Practice Address - Street 1:3434 MIDWAY DR
Practice Address - Street 2:SUITE 2005A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4923
Practice Address - Country:US
Practice Address - Phone:619-501-2195
Practice Address - Fax:619-501-2176
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist