Provider Demographics
NPI:1083673602
Name:PAUL L. KIEFFER
Entity Type:Organization
Organization Name:PAUL L. KIEFFER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:KIEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:570-743-4000
Mailing Address - Street 1:1372 N SUSQUEHANNA TRL
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-8971
Mailing Address - Country:US
Mailing Address - Phone:570-743-4000
Mailing Address - Fax:570-743-3105
Practice Address - Street 1:1372 N SUSQUEHANNA TRL
Practice Address - Street 2:SUITE 250
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-8971
Practice Address - Country:US
Practice Address - Phone:570-743-4000
Practice Address - Fax:570-743-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003918L225100000X
PAPT016781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02406400OtherPA BLUE CROSS GROUP NUMBE
PA45928OtherHEALTH AMERICA GROUP NUMB
PA686027OtherPA BLUE SHIELD GROUP NUMB
PAR06358Medicare UPIN
PA45928OtherHEALTH AMERICA GROUP NUMB