Provider Demographics
NPI:1538217609
Name:MAHAFFEY, RENETTE ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:RENETTE
Middle Name:ELIZABETH
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6038 HOBBY LN
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-4466
Mailing Address - Country:US
Mailing Address - Phone:205-680-6269
Mailing Address - Fax:
Practice Address - Street 1:631 BEACON PKWY W STE 110
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3130
Practice Address - Country:US
Practice Address - Phone:205-945-4859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH2006OtherPHYSICAL THERAPY LICENSE