Healthcare Provider Details

I. General information

NPI: 1063836245
Provider Name (Legal Business Name): KATIE LEEPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 LITITZ PIKE
LANCASTER PA
17601-3321
US

IV. Provider business mailing address

2829 LITITZ PIKE
LANCASTER PA
17601-3321
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberTE010088
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: