Provider Demographics
NPI:1639387566
Name:KIEFER, CAROLYN ANN (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:KIEFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LANDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8381
Mailing Address - Country:US
Mailing Address - Phone:407-658-4959
Mailing Address - Fax:407-658-4919
Practice Address - Street 1:3206 S CONWAY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7348
Practice Address - Country:US
Practice Address - Phone:321-251-7877
Practice Address - Fax:321-206-8212
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY914VOtherBCBS
FLY093LZMedicare ID - Type Unspecified