Provider Demographics
NPI:1558637850
Name:SHAFFO PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:SHAFFO PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SHAFFO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-744-0499
Mailing Address - Street 1:515 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-2702
Mailing Address - Country:US
Mailing Address - Phone:724-744-0499
Mailing Address - Fax:724-744-0499
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:724-744-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005982L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068615Medicare UPIN