Healthcare Provider Details

I. General information

NPI: 1518419944
Provider Name (Legal Business Name): ALYSSA KIEFFER LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S BROADWAY ST
PITTSBURG KS
66762-5856
US

IV. Provider business mailing address

493 EAGLE RD
CLIFTON KS
66937-8842
US

V. Phone/Fax

Practice location:
  • Phone: 785-275-2061
  • Fax:
Mailing address:
  • Phone: 785-275-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2401051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: