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General NPI Number Information
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NPI Number | 1639761513
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Entity Type | Individual
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Provider Name | ANDREW KIFFMEYER DPT
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Gender | Male
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 4765 E 126TH ST
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City | CARMEL
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State | IN
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Zip | 46033-2407
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Country | US
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Telephone | 317-810-0525
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Fax | 463-222-2138
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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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 |
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05014065A
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License Number State | IN
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