Provider Demographics
NPI:1558491126
Name:SHAFFO, JOSEPH LOUIS (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LOUIS
Last Name:SHAFFO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-0445
Mailing Address - Country:US
Mailing Address - Phone:724-744-0499
Mailing Address - Fax:412-374-7294
Practice Address - Street 1:515 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:TRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:15085-2702
Practice Address - Country:US
Practice Address - Phone:724-744-0499
Practice Address - Fax:412-374-7294
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005982L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA336453OtherHEALTH ASSURANCE PENNSYL
PA0005691425OtherAETNA
PA068615Medicare ID - Type UnspecifiedMEDICARE