Provider Demographics
NPI:1457565277
Name:RAFFERTY, BRIAN PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PATRICK
Last Name:RAFFERTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39626 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-9647
Mailing Address - Country:US
Mailing Address - Phone:330-420-0990
Mailing Address - Fax:
Practice Address - Street 1:1995 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2423
Practice Address - Country:US
Practice Address - Phone:330-332-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-007626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist