Provider Demographics
NPI:1386642957
Name:KIEFFER, PAUL L (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:KIEFFER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COURTYARD OFFICES
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9375
Mailing Address - Country:US
Mailing Address - Phone:570-743-4000
Mailing Address - Fax:570-743-3105
Practice Address - Street 1:16 COURTYARD OFFICES
Practice Address - Street 2:SUITE 250
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9375
Practice Address - Country:US
Practice Address - Phone:570-743-4000
Practice Address - Fax:570-743-3105
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
PAPT003918L225100000X
PADAPT000288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028804Medicare ID - Type UnspecifiedGROUP MEDICARE #
PAR06358Medicare UPIN
PA153542Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #