Healthcare Provider Details

I. General information

NPI: 1194661504
Provider Name (Legal Business Name): JESSICA KAUFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 N SHEFFIELD AVE
CHICAGO IL
60657-4419
US

IV. Provider business mailing address

507 AUTUMN AVE SE
NEW PRAGUE MN
56071-3805
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070028479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: