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General NPI Number Information
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NPI Number | 1861904054
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Entity Type | Individual
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Provider Name | EMMA MARIE SHAFFER DPT
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Gender | Female
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Dates
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Enumeration Date | 10/29/2017
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Last Update Date | 10/29/2017
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Provider Practice Location Address
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Address Line | 1500 3RD AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-3229
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Country | US
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Telephone | 360-353-9041
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Fax |
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Provider Business Mailing Address
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Address Line | 4567 WESTSIDE HWY
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City | CASTLE ROCK
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State | WA
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Zip | 98611-9535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 60113895
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License Number State | WA
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