1063151348 NPI number — MARY MARGARET WHELAN LEFFERT DPT

Table of content: MARY MARGARET WHELAN LEFFERT DPT (NPI 1063151348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063151348 NPI number — MARY MARGARET WHELAN LEFFERT DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEFFERT
Provider First Name:
MARY
Provider Middle Name:
MARGARET WHELAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHELAN
Provider Other First Name:
MARY
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063151348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 200880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-0880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-837-7176
Provider Business Mailing Address Fax Number:
404-777-1311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1209 PASEO DEL NORTE STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81008-2083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-569-5691
Provider Business Practice Location Address Fax Number:
719-569-5689
Provider Enumeration Date:
06/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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