Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | OS 013163 | PA |
NPI | 1013038926 |
---|---|
Provider Name | Dr. Keith Lamont Leaphart |
First Address | Philadelphia, PA 19151-2620 |
Second Address | Ardmore, PA 19003-2243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 17/06/2009 |