Provider Demographics
NPI:1154337848
Name:RAFFERTY, KATHLEEN (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1532
Mailing Address - Country:US
Mailing Address - Phone:610-927-5183
Mailing Address - Fax:610-927-6994
Practice Address - Street 1:4728 PENN AVE
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-9672
Practice Address - Country:US
Practice Address - Phone:610-927-5183
Practice Address - Fax:610-927-6994
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist