Provider Demographics
NPI:1245507896
Name:KIEFER, JOSEPH R (MPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:KIEFER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 1A-1B
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3650
Mailing Address - Country:US
Mailing Address - Phone:914-939-6400
Mailing Address - Fax:914-939-6412
Practice Address - Street 1:388 WESTCHESTER AVE
Practice Address - Street 2:SUITE 1A-1B
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3650
Practice Address - Country:US
Practice Address - Phone:914-939-6400
Practice Address - Fax:914-939-6412
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014205-12251P0200X, 251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics