Provider Demographics
NPI:1043475338
Name:KIEFER, EMILY MARIE (PTA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:KIEFER
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 W MISHAWAKA RD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-1921
Mailing Address - Country:US
Mailing Address - Phone:574-293-1550
Mailing Address - Fax:574-970-4698
Practice Address - Street 1:333 W MISHAWAKA RD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-1921
Practice Address - Country:US
Practice Address - Phone:574-293-1550
Practice Address - Fax:574-970-4698
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003218A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant