Provider Demographics
NPI:1013038926
Name:LEAPHART, KEITH LAMONT (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LAMONT
Last Name:LEAPHART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:76 RITTENHOUSE PL
Practice Address - Street 2:SUITE 201
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2243
Practice Address - Country:US
Practice Address - Phone:484-416-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 013163208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation