Provider Demographics
NPI:1245659697
Name:KAFANTARIS, CLAIRE FELLOWS (PT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:FELLOWS
Last Name:KAFANTARIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:FELLOWS
Other - Last Name:KUBIZNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1055 CETRONIA RD
Mailing Address - Street 2:APARTMENT O-2
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1681
Mailing Address - Country:US
Mailing Address - Phone:302-521-3305
Mailing Address - Fax:
Practice Address - Street 1:1055 CETRONIA RD
Practice Address - Street 2:APARTMENT O-2
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1681
Practice Address - Country:US
Practice Address - Phone:302-521-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist