Provider Demographics
NPI:1750679783
Name:KAUFFMAN, SUZANNE (LMT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6927
Mailing Address - Country:US
Mailing Address - Phone:480-323-5372
Mailing Address - Fax:
Practice Address - Street 1:1757 E BASELINE RD
Practice Address - Street 2:BLDG 10 SUITE 140
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1532
Practice Address - Country:US
Practice Address - Phone:480-633-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-02519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist