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NPI Code Detail

MEDICARE: CATHERINE TUCKER SHAFFER LPTA

MEDICARE: CATHERINE TUCKER SHAFFER LPTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2720NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1U03370793 02OTHERNCCIGNA

General Provider Information

NPI Number : 1366566325
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHERINE TUCKER SHAFFER LPTA
Provider Business Mailing Address
First Line : 3112 SPRUNT AVE
Second Line :
City : DURHAM
State : NC
Zip : 27705-3023
Country : US
Telephone Number : 919-309-7415
Fax Number :
Provider Business Practice Location Address
First Line : 300 MEADOWLAND DR
Second Line :
City : HILLSBOROUGH
State : NC
Zip : 27278-8502
Country : US
Telephone Number : 919-732-2258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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