Provider Demographics
NPI:1174838692
Name:LAFFERTY, BERNADETTE LEE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:LEE
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S. ROAD 1 WEST
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323
Mailing Address - Country:US
Mailing Address - Phone:928-925-3051
Mailing Address - Fax:
Practice Address - Street 1:634 SCHEMMER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2362
Practice Address - Country:US
Practice Address - Phone:928-925-3051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-13777225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist