Provider Demographics
NPI:1285204784
Name:KAUFFMAN, JAYDE DANIELLE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JAYDE
Middle Name:DANIELLE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1864
Mailing Address - Country:US
Mailing Address - Phone:484-818-1097
Mailing Address - Fax:
Practice Address - Street 1:2 WALT RD
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1732
Practice Address - Country:US
Practice Address - Phone:484-818-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0067682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer