Provider Demographics
NPI:1881816577
Name:LEIKAS, KEITH HENRY (PT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:HENRY
Last Name:LEIKAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ROBERTS ST N
Mailing Address - Street 2:UNIT 1
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4981
Mailing Address - Country:US
Mailing Address - Phone:701-237-5591
Mailing Address - Fax:701-234-7961
Practice Address - Street 1:2400 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5800
Practice Address - Country:US
Practice Address - Phone:701-234-8700
Practice Address - Fax:701-234-7961
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic