Provider Demographics
NPI:1750831772
Name:MAHAFFEY, JANE (PTA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-9160
Mailing Address - Country:US
Mailing Address - Phone:570-772-7794
Mailing Address - Fax:
Practice Address - Street 1:97 WAGNER RD
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-9160
Practice Address - Country:US
Practice Address - Phone:570-772-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000137225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant