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General NPI Number Information
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NPI Number | 1245353580
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Entity Type | Individual
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Provider Name | KERRY RICHARD KLIEVER MPT
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 250 INTERNATIONAL PKWY SUITE 260
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City | LAKE MARY
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State | FL
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Zip | 32746-5030
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Country | US
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Telephone | 407-833-8815
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Fax |
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Provider Business Mailing Address
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Address Line | 350 ARLOWENE CT
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City | JEFFERSON
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State | OR
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Zip | 97352-9481
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Country | US
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Telephone | 541-619-0966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3458
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License Number State | OR
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