Provider Demographics
NPI:1366783425
Name:KAFFREY, SHIRLEY K
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:K
Last Name:KAFFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 MCNIEL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4921
Mailing Address - Country:US
Mailing Address - Phone:719-238-9967
Mailing Address - Fax:
Practice Address - Street 1:3006 MCNIEL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-4921
Practice Address - Country:US
Practice Address - Phone:719-238-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012406225200000X
TX2173391225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant