Provider Demographics
NPI:1477295913
Name:KIEFFER, ABIGAIL MARTIN
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARTIN
Last Name:KIEFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 RIVERMONT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5991
Mailing Address - Country:US
Mailing Address - Phone:931-572-7169
Mailing Address - Fax:
Practice Address - Street 1:2319 RUDOLPHTOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2228
Practice Address - Country:US
Practice Address - Phone:931-572-7169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7947225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant