Provider Demographics
NPI:1154516862
Name:KAUFMAN, TIMOTHY A (DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LONG POND ROAD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-746-6922
Mailing Address - Fax:508-746-7211
Practice Address - Street 1:31 SCHOOSETT STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359
Practice Address - Country:US
Practice Address - Phone:781-924-5289
Practice Address - Fax:781-924-5247
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA18031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA382301Medicare PIN