Provider Demographics
NPI:1740625763
Name:KAUFFMAN, ELIZABETH A (MPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3101
Mailing Address - Country:US
Mailing Address - Phone:307-332-2715
Mailing Address - Fax:307-332-0314
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3101
Practice Address - Country:US
Practice Address - Phone:307-332-2715
Practice Address - Fax:307-332-0314
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-0743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist