Healthcare Provider Details

I. General information

NPI: 1881759736
Provider Name (Legal Business Name): STEPHANIE MCCAFFREY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BON AIR RD SUITE A-105
LARKSPUR CA
94939-1143
US

IV. Provider business mailing address

5 BON AIR RD SUITE A-105
LARKSPUR CA
94939-1143
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-2007
  • Fax: 415-927-7272
Mailing address:
  • Phone: 415-927-2007
  • Fax: 415-927-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberPT13315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: