Provider Demographics
NPI:1992016398
Name:MEJIA-JEFFRIES, KAELIN NICHOLE (DPT)
Entity Type:Individual
Prefix:
First Name:KAELIN
Middle Name:NICHOLE
Last Name:MEJIA-JEFFRIES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 TRINDLE RD
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4413
Mailing Address - Country:US
Mailing Address - Phone:717-920-2620
Mailing Address - Fax:717-920-2621
Practice Address - Street 1:3399 TRINDLE RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4413
Practice Address - Country:US
Practice Address - Phone:717-920-2620
Practice Address - Fax:717-920-2621
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA195174F9GMedicare Oscar/Certification