Provider Demographics
NPI:1841574647
Name:LAFFERTY, MAUREEN L (PTA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:LAFFERTY
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 1:201 E 2ND ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2582
Mailing Address - Country:US
Mailing Address - Phone:307-337-1624
Mailing Address - Fax:307-337-1626
Practice Address - Street 1:201 E 2ND ST
Practice Address - Street 2:SUITE 14
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2582
Practice Address - Country:US
Practice Address - Phone:307-337-1624
Practice Address - Fax:307-337-1626
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPTA0427225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant