Provider Demographics
NPI:1366566325
Name:SHAFFER, CATHERINE TUCKER (LPTA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:TUCKER
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 SPRUNT AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3023
Mailing Address - Country:US
Mailing Address - Phone:919-309-7415
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOWLAND DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8502
Practice Address - Country:US
Practice Address - Phone:919-732-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2720225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU03370793 02OtherCIGNA