Healthcare Provider Details

I. General information

NPI: 1730440918
Provider Name (Legal Business Name): JENNIFER STAUFFER COGDILL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER RUTH STAUFFER P.T.

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 HIGHLAND PARK DR SUITE 1
RICHMOND KY
40475-3546
US

IV. Provider business mailing address

113 WELCHWOOD DR
BEREA KY
40403-9795
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-4567
  • Fax:
Mailing address:
  • Phone: 859-985-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005130
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: