Provider Demographics
NPI:1134359938
Name:LAFFERTY, KALI A (PT)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:A
Last Name:LAFFERTY
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 1:6015 POINTE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5532
Mailing Address - Country:US
Mailing Address - Phone:941-782-2000
Mailing Address - Fax:941-782-2011
Practice Address - Street 1:6015 POINTE WEST BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5532
Practice Address - Country:US
Practice Address - Phone:941-782-2000
Practice Address - Fax:941-782-2011
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00949708OtherRAIL ROAD MEDICARE