MEDICARE: SHAFFO PHYSICAL THERAPY INC.

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
1	261QP2000X	Physical Therapy Clinic/Center	PT005982L	PA

General Provider Information

NPI Number	:	1558637850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAFFO PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	515 PLEASANT VALLEY RD
Second Line	:
City	:	TRAFFORD
State	:	PA
Zip	:	15085-2702
Country	:	US
Telephone Number	:	724-744-0499
Fax Number	:	724-744-0499

Provider Business Practice Location Address
First Line	:	515 PLEASANT VALLEY RD
Second Line	:
City	:	TRAFFORD
State	:	PA
Zip	:	15085-2702
Country	:	US
Telephone Number	:	724-744-0499
Fax Number	:	724-744-0499

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. JOSEPH LOUIS SHAFFO
Credential	:	PT
Telephone Number	:	724-744-0499

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	03/30/2012

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