Provider Demographics
NPI:1386203107
Name:SHAFFER, KAITLYNN MOSTARD (DPT)
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:MOSTARD
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAITLYNN
Other - Middle Name:A
Other - Last Name:MOSTARD-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:565 W. NESHANNOCK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142
Mailing Address - Country:US
Mailing Address - Phone:724-946-3313
Mailing Address - Fax:724-946-2770
Practice Address - Street 1:1599 N. HERMITAGE RD.
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148
Practice Address - Country:US
Practice Address - Phone:724-962-7920
Practice Address - Fax:724-962-6029
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist