Provider Demographics
NPI:1407892433
Name:KAUFMAN, JANE SUSAN (PT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:SUSAN
Last Name:KAUFMAN
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:PO BOX 4061
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05406
Mailing Address - Country:US
Mailing Address - Phone:802-863-6662
Mailing Address - Fax:802-861-2224
Practice Address - Street 1:ONE KENNEDY DRIVE
Practice Address - Street 2:SUITE L2
Practice Address - City:SO BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-863-6662
Practice Address - Fax:802-861-2224
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400000866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4726OtherTVHP
VT714581OtherMVP
VT1007600Medicaid
VT5277601OtherFAHC
VT11351767OtherCAQH
VT4726OtherBLUE CROSS BLUE SHIELD
VTVN 2575Medicare PIN