| NPI | 1982040846 |
|---|---|
| Former Name | KAITLYN MARTHA SHAFFER |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT004052) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WV 001831) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2019-01-09 |