1336324003 NPI number — RENEE JEAN MCCAFFREY MPT

Table of content: RENEE JEAN MCCAFFREY MPT (NPI 1336324003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336324003 NPI number — RENEE JEAN MCCAFFREY MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCAFFREY
Provider First Name:
RENEE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336324003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2305 OLYMPIC DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-245-3142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9401 SW SR 200 BLDG 2000
Provider Second Line Business Practice Location Address:
BETTER BODY PHYSICAL THERAPY SUITE 2001
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-854-4017
Provider Business Practice Location Address Fax Number:
352-854-4389
Provider Enumeration Date:
12/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , with the licence number:  PT 23750 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)