Healthcare Provider Details

I. General information

NPI: 1669902920
Provider Name (Legal Business Name): KATHLEEN MCAULIFFE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN KUJAWA

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 INDIAN WARPATH DR
PACIFIC MO
63069-3462
US

IV. Provider business mailing address

101 INDIAN WARPATH DR
PACIFIC MO
63069-3462
US

V. Phone/Fax

Practice location:
  • Phone: 636-271-1459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2017018710
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: