Provider Demographics
NPI:1124273701
Name:MCCAFFREY, TANYA SUSAN (PT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:SUSAN
Last Name:MCCAFFREY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:SUSAN
Other - Last Name:YUHAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:201 N COLLEGE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4614
Mailing Address - Country:US
Mailing Address - Phone:805-922-1724
Mailing Address - Fax:805-922-2765
Practice Address - Street 1:255 NORTH WILLSON
Practice Address - Street 2:SUITE C
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444
Practice Address - Country:US
Practice Address - Phone:805-929-3230
Practice Address - Fax:805-929-3232
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist