Provider Demographics
NPI:1477632834
Name:SHEAFFER, GARY LYNN JR (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LYNN
Last Name:SHEAFFER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2340 CANEY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-8926
Mailing Address - Country:US
Mailing Address - Phone:803-604-1479
Mailing Address - Fax:803-604-1479
Practice Address - Street 1:2340 CANEY BRANCH RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-8926
Practice Address - Country:US
Practice Address - Phone:803-604-1479
Practice Address - Fax:803-604-1479
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist