Provider Demographics
NPI:1518419944
Name:KIEFFER, ALYSSA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:KIEFFER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:KS
Mailing Address - Zip Code:66937-8842
Mailing Address - Country:US
Mailing Address - Phone:785-275-2061
Mailing Address - Fax:
Practice Address - Street 1:1701 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-5856
Practice Address - Country:US
Practice Address - Phone:785-275-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24010512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer