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General NPI Number Information
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NPI Number | 1730440918
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Entity Type | Individual
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Provider Name | JENNIFER STAUFFER COGDILL P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 370 HIGHLAND PARK DR SUITE 1
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City | RICHMOND
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State | KY
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Zip | 40475-3546
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Country | US
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Telephone | 859-623-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 113 WELCHWOOD DR
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City | BEREA
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State | KY
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Zip | 40403-9795
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Country | US
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Telephone | 859-985-5825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 005130
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License Number State | KY
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