Healthcare Provider Details

I. General information

NPI: 1972795615
Provider Name (Legal Business Name): SARA BREANNA GAFFNEY D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 TRANSFER RD STE 16
SAINT PAUL MN
55114-1427
US

IV. Provider business mailing address

2714 MORGAN AVE N
MINNEAPOLIS MN
55411-1131
US

V. Phone/Fax

Practice location:
  • Phone: 651-646-1625
  • Fax: 651-646-3256
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7983
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: