MEDICARE: DR. ALAN M LAFKY DPT

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	225100000X	Physical Therapist	PT10252	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000008368	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1619076452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN M LAFKY DPT

Provider Business Mailing Address
First Line	:	1296 WINDSOR DR
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-8018
Country	:	US
Telephone Number	:	937-367-4119
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 ORCHARD LN
Second Line	:	SUITE 201
City	:	BEAVERCREEK TOWNSHIP
State	:	OH
Zip	:	45434-7229
Country	:	US
Telephone Number	:	937-367-4119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/23/2011

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