Individual provider Active NPI

Samantha Kaufman, DPT

  • Physical Therapist
  • Grafton, WI
National Provider Identifier
1588073928
Registry record updated Jul 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12786-24 Issued in WI
Practice address
2020 Cheyenne CT
Grafton, WI 53024-9368
Phone
(262) 375-1075
Fax
(262) 375-4975
NPI assigned
Aug 11, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 12786-24 WI Primary

Addresses

Primary practice location

2020 Cheyenne CT
Grafton, WI 53024-9368

Mailing address

2020 Cheyenne CT
Grafton, WI 53024-9368
Phone (920) 968-0814

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12786-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Sport & Spine, LLC Physical Therapist PastSince Nov 2, 2013 Accepting new patients
Body Renovation Health Services, S.C. PastSince Jun 28, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625443200000",
    "number": "1588073928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 CHEYENNE CT",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249368",
            "telephone_number": "920-968-0814",
            "fax_number": "920-734-6159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 CHEYENNE CT",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249368",
            "telephone_number": "262-375-1075",
            "fax_number": "262-375-4975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUFMAN",
        "first_name": "SAMANTHA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-11",
        "last_updated": "2021-07-05",
        "certification_date": "2021-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "12786-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grafton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.