MEDICARE: DANINE LEEPER

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	225200000X	Physical Therapy Assistant	06002226A	IN

General Provider Information

NPI Number	:	1104684364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANINE LEEPER

Provider Business Mailing Address
First Line	:	9650 GEIST WOODS WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-9630
Country	:	US
Telephone Number	:	317-654-4573
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 DECATUR BLVD STE 175
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-9625
Country	:	US
Telephone Number	:	317-343-4549
Fax Number	:	317-343-4549

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

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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Directions to “ DANINE LEEPER ” Practice Location

Language	Start Address	Practice Location

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