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General NPI Number Information
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NPI Number | 1144509266
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Entity Type | Individual
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Provider Name | LEIA DAWN DEPPERSCHMIDT PTA
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Gender | Female
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Dates
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Enumeration Date | 08/07/2011
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Last Update Date | 08/07/2011
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Provider Practice Location Address
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Address Line | 510 CENTENNIAL CIR
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City | NORTH PLATTE
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State | NE
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Zip | 69101-6586
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Country | US
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Telephone | 308-696-0074
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Fax | 308-696-0074
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Provider Business Mailing Address
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Address Line | 1110 W 9TH ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-2816
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Country | US
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Telephone | 308-660-4195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 834
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License Number State | NE
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