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NPI Code Detail

MEDICARE: DR. DERRICK LYNN LEEPER PT, DPT

MEDICARE: DR. DERRICK LYNN LEEPER PT, DPT
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1386203800
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DERRICK LYNN LEEPER PT, DPT
Provider Business Mailing Address
First Line : 4940 W STATE ROUTE HH
Second Line :
City : KINGSTON
State : MO
Zip : 64650-9724
Country : US
Telephone Number : 816-284-3448
Fax Number :
Provider Business Practice Location Address
First Line : 6840 S UNIVERSITY BLVD STE 400
Second Line :
City : CENTENNIAL
State : CO
Zip : 80122-1510
Country : US
Telephone Number : 303-771-5120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2019
Last Update Date : 06/08/2019

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