Provider Demographics
NPI:1205312535
Name:KAUFMAN, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:PA
Mailing Address - Zip Code:16049-2514
Mailing Address - Country:US
Mailing Address - Phone:724-504-0307
Mailing Address - Fax:
Practice Address - Street 1:776 STATE ROUTE 58
Practice Address - Street 2:
Practice Address - City:FOXBURG
Practice Address - State:PA
Practice Address - Zip Code:16036
Practice Address - Country:US
Practice Address - Phone:724-659-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0070492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer