Provider Demographics
NPI:1003330473
Name:KIFER, MATTHEW E (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:KIFER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7495
Mailing Address - Country:US
Mailing Address - Phone:208-773-2888
Mailing Address - Fax:208-806-0222
Practice Address - Street 1:640 N THORNTON ST
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7495
Practice Address - Country:US
Practice Address - Phone:208-773-2888
Practice Address - Fax:208-806-0222
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6533225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-6533OtherPHYSICAL THERAPY LICENSE