Provider Demographics
NPI:1386095610
Name:KAUFFMAN, DAVID CHARLES (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HEDGES ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2615
Mailing Address - Country:US
Mailing Address - Phone:307-332-9378
Mailing Address - Fax:
Practice Address - Street 1:511 N 12TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3809
Practice Address - Country:US
Practice Address - Phone:307-856-9281
Practice Address - Fax:307-463-4489
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY750225100000X
NMPT-2024-0171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114828101Medicaid