Provider Demographics
NPI:1174563712
Name:MCCAFFERTY, WILLIAM C (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:MCCAFFERTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 MOREBORO RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3953
Mailing Address - Country:US
Mailing Address - Phone:215-443-5087
Mailing Address - Fax:
Practice Address - Street 1:15 VILLAGE SQ, LOGAN SQ
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938
Practice Address - Country:US
Practice Address - Phone:215-862-4195
Practice Address - Fax:215-862-4197
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006682L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA644790OtherBLUE SHIELD
PA30018441OtherKEYSTONE MERCY
PA0475557000OtherAMERIHEALTH
PA023235Medicare ID - Type Unspecified
PA30018441OtherKEYSTONE MERCY