Provider Demographics
NPI:1932405636
Name:KELLER, LEAH D (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:D
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:D
Other - Last Name:BINSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:509 BURLINGTON ST SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4272
Mailing Address - Country:US
Mailing Address - Phone:701-290-8446
Mailing Address - Fax:
Practice Address - Street 1:509 BURLINGTON ST SE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-4272
Practice Address - Country:US
Practice Address - Phone:701-290-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist