Provider Demographics
NPI:1508195983
Name:KAUFMAN, KEITH C (MSPT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:C
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 MCDOUGALL DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3515
Mailing Address - Country:US
Mailing Address - Phone:307-349-0711
Mailing Address - Fax:
Practice Address - Street 1:8204 HIGHWAY 789
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2941
Practice Address - Country:US
Practice Address - Phone:307-349-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT - 1088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist