1386787059 NPI number — PIETER ALBERT DE LEPPER P.T., OCS, CERT. MDT

Table of content: PIETER ALBERT DE LEPPER P.T., OCS, CERT. MDT (NPI 1386787059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386787059 NPI number — PIETER ALBERT DE LEPPER P.T., OCS, CERT. MDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LEPPER
Provider First Name:
PIETER
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., OCS, CERT. MDT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LEPPER
Provider Other First Name:
FRED
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386787059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 2ND ST E
Provider Second Line Business Mailing Address:
SUITE 222
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-6110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-257-8250
Provider Business Mailing Address Fax Number:
406-257-8253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 2ND ST E
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-257-8250
Provider Business Practice Location Address Fax Number:
406-257-8253
Provider Enumeration Date:
02/14/2007

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 , with the licence number:  422 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3400007 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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