Healthcare Provider Details

I. General information

NPI: 1376002972
Provider Name (Legal Business Name): DANIEL LEIB PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 S 27TH ST
FRANKLIN WI
53132-7209
US

IV. Provider business mailing address

10101 S 27TH ST
FRANKLIN WI
53132-7209
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-4952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number14390-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: