Provider Demographics
NPI:1245679414
Name:KAUFMAN, MARY MORGAN (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MORGAN
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 W 103RD ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2640
Mailing Address - Country:US
Mailing Address - Phone:913-322-4000
Mailing Address - Fax:
Practice Address - Street 1:2311 S KANSAS RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9032
Practice Address - Country:US
Practice Address - Phone:316-669-1648
Practice Address - Fax:316-803-1516
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist