Provider Demographics
NPI:1427787522
Name:KIEFFER, KACIE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:MARIE
Last Name:KIEFFER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 DOUGLAS GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-5040
Mailing Address - Country:US
Mailing Address - Phone:318-209-8963
Mailing Address - Fax:
Practice Address - Street 1:1500 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-6655
Practice Address - Country:US
Practice Address - Phone:318-957-5044
Practice Address - Fax:318-699-8843
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist