Provider Demographics
NPI:1700958741
Name:RAFFERTY, KAREN A (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571-0529
Mailing Address - Country:US
Mailing Address - Phone:516-766-7848
Mailing Address - Fax:516-763-9889
Practice Address - Street 1:235 MERRICK RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5211
Practice Address - Country:US
Practice Address - Phone:516-766-7848
Practice Address - Fax:516-766-4849
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY024144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ30H71Medicare Oscar/Certification
NYQ30H71Medicare PIN