Provider Demographics
NPI:1457820532
Name:MAHAFFEY, BROOKKE DANNYEL (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BROOKKE
Middle Name:DANNYEL
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-9704
Mailing Address - Country:US
Mailing Address - Phone:814-472-3275
Mailing Address - Fax:814-472-2786
Practice Address - Street 1:117 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-9704
Practice Address - Country:US
Practice Address - Phone:814-472-3275
Practice Address - Fax:814-472-2786
Is Sole Proprietor?:No
Enumeration Date:2018-11-18
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0060852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer