MEDICARE: PAUL L. KIEFFER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT003918L	PA
2	225100000X	Physical Therapist	PT016781	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02406400	OTHER	PA	PA BLUE CROSS GROUP NUMBE
2	45928	OTHER	PA	HEALTH AMERICA GROUP NUMB
3	686027	OTHER	PA	PA BLUE SHIELD GROUP NUMB

General Provider Information

NPI Number	:	1083673602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL L. KIEFFER

Provider Business Mailing Address
First Line	:	1372 N SUSQUEHANNA TRL
Second Line	:	SUITE 250
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-8971
Country	:	US
Telephone Number	:	570-743-4000
Fax Number	:	570-743-3105

Provider Business Practice Location Address
First Line	:	1372 N SUSQUEHANNA TRL
Second Line	:	SUITE 250
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-8971
Country	:	US
Telephone Number	:	570-743-4000
Fax Number	:	570-743-3105

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PAUL LESLIE KIEFFER
Credential	:	P.T.
Telephone Number	:	570-743-4000

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	08/15/2008

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Directions to “PAUL L. KIEFFER ” Practice Location

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