Provider Demographics
NPI:1003871120
Name:VAN DER KIEFT, DANA F (PT)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:F
Last Name:VAN DER KIEFT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52194
Mailing Address - Street 2:DEPT CODE 960
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2194
Mailing Address - Country:US
Mailing Address - Phone:503-489-1781
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:308 N IVY ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3704
Practice Address - Country:US
Practice Address - Phone:503-263-6786
Practice Address - Fax:503-263-6451
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR114519Medicare PIN
ORR138063Medicare PIN
ORR142644Medicare PIN
ORR114556Medicare PIN
ORR142655Medicare PIN
ORR114778Medicare PIN