Provider Demographics
NPI:1548263601
Name:KAUFFMAN, KATHLINE DONICE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLINE
Middle Name:DONICE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 N 358TH AVE
Mailing Address - Street 2:
Mailing Address - City:TONOPAH
Mailing Address - State:AZ
Mailing Address - Zip Code:85354-7929
Mailing Address - Country:US
Mailing Address - Phone:602-448-6596
Mailing Address - Fax:
Practice Address - Street 1:1312 N 358TH AVE
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:AZ
Practice Address - Zip Code:85354-7929
Practice Address - Country:US
Practice Address - Phone:602-957-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ544842Medicaid
AZ78668Medicare ID - Type Unspecified