Provider Demographics
NPI:1003207366
Name:CHOUFANI, KAWSAR (DPT)
Entity type:Individual
Prefix:
First Name:KAWSAR
Middle Name:
Last Name:CHOUFANI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 N LIPKEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:44451-9665
Mailing Address - Country:US
Mailing Address - Phone:330-538-9822
Mailing Address - Fax:330-538-9820
Practice Address - Street 1:2675 N LIPKEY RD
Practice Address - Street 2:
Practice Address - City:NORTH JACKSON
Practice Address - State:OH
Practice Address - Zip Code:44451-9665
Practice Address - Country:US
Practice Address - Phone:330-538-9822
Practice Address - Fax:330-538-9820
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist