Active NPI
Addison Kaufmann
- Physical Therapist
- Fairmont, WV
National Provider Identifier
1093593857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT004682
- Practice address
- 1228 Country Club Rd Ste 15
Fairmont, WV 26554-2377 - Phone
- (304) 366-0461
- NPI assigned
- Sep 21, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT004682 | WV | Primary |
Addresses
Primary practice location
1228 Country Club Rd Ste 15
Fairmont, WV 26554-2377
Mailing address
170 Pride Ridge Rd
Fairmont, WV 26554-6398
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231214003776 | WV | Practitioner - Physical Therapist in Private Practice | 4486003498 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT004682 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695254400000",
"number": "1093593857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "170 PRIDE RIDGE RD",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265546398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1228 COUNTRY CLUB RD STE 15",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265542377",
"telephone_number": "304-366-0461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAUFMANN",
"first_name": "ADDISON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-21",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "PT004682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.