Provider Demographics
NPI:1265747315
Name:MCCAFFREY, KELSIE ANN (DPT)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:ANN
Last Name:MCCAFFREY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:ANN
Other - Last Name:GANSHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:330 EAST 39TH ST, APT 3P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:949-584-9544
Mailing Address - Fax:
Practice Address - Street 1:1630 SW MORRISON ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1916
Practice Address - Country:US
Practice Address - Phone:503-227-7774
Practice Address - Fax:503-227-7548
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist