Provider Demographics
NPI:1790321909
Name:KAUFMAN, CELESTE (LMT)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:KAUFMAN
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 1:19082 N R H JOHNSON BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4482
Mailing Address - Country:US
Mailing Address - Phone:602-397-2199
Mailing Address - Fax:
Practice Address - Street 1:19116 N COLONNADE WAY
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7223
Practice Address - Country:US
Practice Address - Phone:602-397-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist