Provider Demographics
NPI:1659911337
Name:MAHAFFEY, EMILY (DPT, CLT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 GRAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2040
Mailing Address - Country:US
Mailing Address - Phone:804-475-7310
Mailing Address - Fax:
Practice Address - Street 1:14051 ST FRANCIS BLVD STE 2202
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3203
Practice Address - Country:US
Practice Address - Phone:804-594-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist