Provider Demographics
NPI:1326698135
Name:STAUFFER, KIRSTEN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:FOLZENLOGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 COLONY GARDENS RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1231
Mailing Address - Country:US
Mailing Address - Phone:614-735-2712
Mailing Address - Fax:
Practice Address - Street 1:89 SOUTH ST
Practice Address - Street 2:UNIT 102
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-226-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212732225100000X
OHPT018059225100000X
MA24563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE