Provider Demographics
NPI:1518014620
Name:GAFFNEY, PAUL W (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:GAFFNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:491 ALLENDALE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1426
Mailing Address - Country:US
Mailing Address - Phone:610-337-7155
Mailing Address - Fax:610-337-7111
Practice Address - Street 1:491 ALLENDALE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1426
Practice Address - Country:US
Practice Address - Phone:610-337-7155
Practice Address - Fax:610-337-7111
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000096E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30046OtherAETNA HMO PROVIDER NUMBER
PA4358754OtherAETNA PROVIDER NUMBER
PA1160690OtherKEYSTONE MERCY
PA0049563000OtherINDEPENDENCE BLUE CROSS
PA2Y4335OtherHEALTHNET
PA1740457Medicaid
PA2Y4335OtherHEALTHNET