Provider Demographics
NPI:1336145648
Name:LEPPERT, KAREN M
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:LEPPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FISHERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15539-9840
Mailing Address - Country:US
Mailing Address - Phone:814-839-2838
Mailing Address - Fax:814-814-2340
Practice Address - Street 1:3029 VALLEY RD
Practice Address - Street 2:
Practice Address - City:FISHERTOWN
Practice Address - State:PA
Practice Address - Zip Code:15539-9840
Practice Address - Country:US
Practice Address - Phone:814-839-2838
Practice Address - Fax:814-839-2340
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013545L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021476680001Medicaid
PA056727QFHMedicare ID - Type Unspecified