Provider Demographics
NPI:1619064482
Name:GIFFUNE, MARY LOUISE (DPT, MSPT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE
Last Name:GIFFUNE
Suffix:
Gender:F
Credentials:DPT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E 10TH ST
Mailing Address - Street 2:APT. A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7703
Mailing Address - Country:US
Mailing Address - Phone:212-420-1247
Mailing Address - Fax:
Practice Address - Street 1:206 EAST 10TH ST
Practice Address - Street 2:APT. A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024715-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist