MEDICARE: ALLISON M KLEEFISCH

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		MN

General Provider Information

NPI Number	:	1174043624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON M KLEEFISCH

Provider Business Mailing Address
First Line	:	16295 W HEATHERLY DR
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-9236
Country	:	US
Telephone Number	:	12623493392
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E 28TH ST STE 2704
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3723
Country	:	US
Telephone Number	:	612-863-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	06/26/2017

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