Provider Demographics
NPI:1265974901
Name:GAFFNEY PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:GAFFNEY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT, OT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAFFNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OTR/L, MSPT
Authorized Official - Phone:401-228-3939
Mailing Address - Street 1:1193 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6008
Mailing Address - Country:US
Mailing Address - Phone:401-228-3939
Mailing Address - Fax:401-383-3043
Practice Address - Street 1:1193 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6008
Practice Address - Country:US
Practice Address - Phone:401-228-3939
Practice Address - Fax:401-383-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01001225X00000X
RIPT01874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty