Provider Demographics
NPI:1316282213
Name:GAFFORD, DARRYL M (MPT)
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:M
Last Name:GAFFORD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11486 VIA LIDO
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3827
Mailing Address - Country:US
Mailing Address - Phone:909-205-9275
Mailing Address - Fax:
Practice Address - Street 1:11486 VIA LIDO
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3827
Practice Address - Country:US
Practice Address - Phone:909-205-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 349502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic