Basic Information
Provider Information
NPI: 1326375668
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAUFHOLD
FirstName: KIMBERLY
MiddleName: RAE
NamePrefix: MRS.
NameSuffix:  
Credential: LPTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 710 JULIAN RD
Address2:  
City: SALISBURY
State: NC
PostalCode: 281477510
CountryCode: US
TelephoneNumber: 7046365812
FaxNumber:  
Practice Location
Address1: 710 JULIAN RD
Address2:  
City: SALISBURY
State: NC
PostalCode: 281477510
CountryCode: US
TelephoneNumber: 7046365812
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/06/2009
LastUpdateDate: 11/06/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X935NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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