Provider Demographics
NPI:1588613087
Name:SCHAFFER, KIM CARRERAS (MSPT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:CARRERAS
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18934 SW 93RD CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7954
Mailing Address - Country:US
Mailing Address - Phone:305-742-3125
Mailing Address - Fax:305-232-7053
Practice Address - Street 1:18934 SW 93RD CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7954
Practice Address - Country:US
Practice Address - Phone:305-742-3125
Practice Address - Fax:305-232-7053
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886457800Medicaid