Provider Demographics
NPI:1548556202
Name:PFEIFF, KRISTIE JOLENE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:JOLENE
Last Name:PFEIFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:NE
Mailing Address - Zip Code:69165-3000
Mailing Address - Country:US
Mailing Address - Phone:308-386-4393
Mailing Address - Fax:308-386-4378
Practice Address - Street 1:333 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:NE
Practice Address - Zip Code:69165-3000
Practice Address - Country:US
Practice Address - Phone:308-386-4393
Practice Address - Fax:308-386-4378
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE166225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant