Provider Demographics
NPI:1043608599
Name:KIPHUTH, STEVEN (ATC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KIPHUTH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 14TH ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2966
Mailing Address - Country:US
Mailing Address - Phone:763-684-3893
Mailing Address - Fax:
Practice Address - Street 1:101 14TH ST NE STE A
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2966
Practice Address - Country:US
Practice Address - Phone:763-684-3893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer