Provider Demographics
NPI:1801921796
Name:SHAFER, GAIL (MPT)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:
Last Name:SHAFER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 STATE ROUTE 9H
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-3825
Mailing Address - Country:US
Mailing Address - Phone:518-851-2631
Mailing Address - Fax:518-851-6631
Practice Address - Street 1:81 STATE ROUTE 9H
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3825
Practice Address - Country:US
Practice Address - Phone:518-851-2631
Practice Address - Fax:518-851-6631
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020631-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9732705OtherGROUP COMMERCIAL GHI
NYP3573142OtherOXFORD
NYGS0QT18410OtherGENERAL COMMERCIAL
NYGS0QT18410OtherGENERAL COMMERCIAL