Provider Demographics
NPI:1912440132
Name:LEPPERT, BRIAN (LMT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LEPPERT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 N KEYSTONE CT
Mailing Address - Street 2:#26
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6282
Mailing Address - Country:US
Mailing Address - Phone:208-215-1001
Mailing Address - Fax:
Practice Address - Street 1:1813 N KEYSTONE CT
Practice Address - Street 2:#26
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6282
Practice Address - Country:US
Practice Address - Phone:208-215-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-19
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3004175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath