Provider Demographics
NPI:1730440918
Name:COGDILL, JENNIFER STAUFFER (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:STAUFFER
Last Name:COGDILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RUTH
Other - Last Name:STAUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:113 WELCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9795
Mailing Address - Country:US
Mailing Address - Phone:859-985-5825
Mailing Address - Fax:
Practice Address - Street 1:370 HIGHLAND PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3546
Practice Address - Country:US
Practice Address - Phone:859-623-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist