Provider Demographics
NPI:1649341041
Name:SHAFFER, DANA P (PT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:P
Last Name:SHAFFER
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 1:625 LINCOLN AVE
Mailing Address - Street 2:SUITE 107 PROFESSIONAL PLAZA
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2451
Mailing Address - Country:US
Mailing Address - Phone:724-483-1673
Mailing Address - Fax:724-483-0290
Practice Address - Street 1:625 LINCOLN AVE
Practice Address - Street 2:SUITE 107 PROFESSIONAL PLAZA
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-2451
Practice Address - Country:US
Practice Address - Phone:724-483-1673
Practice Address - Fax:724-483-0290
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396610OtherMEDICARE
PA0015935850001Medicaid
PA0016749970003Medicaid
PA396751OtherMEDICARE