Healthcare Provider Details

I. General information

NPI: 1487559746
Provider Name (Legal Business Name): COLIN KLEFFMAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL CAMPUS DR NW STE 204
SUPPLY NC
28462-4094
US

IV. Provider business mailing address

13861 HAPPY GO LUCKY RD
PILLAGER MN
56473-2573
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-5861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: