Provider Demographics
NPI:1588849210
Name:HAEFNER, AMY E (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:HAEFNER
Suffix:
Gender:F
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 105
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886
Mailing Address - Country:US
Mailing Address - Phone:607-256-1839
Mailing Address - Fax:
Practice Address - Street 1:3226 WILKENS RD
Practice Address - Street 2:RACKER CENTERS
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14886
Practice Address - Country:US
Practice Address - Phone:607-272-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0115441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist