Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT008902L | PA |
N | 2081S0010X | Sports Medicine | PT008902L | PA |
N | 213ES0000X | Sports Medicine | PT008902L | PA |
NPI | 1497748933 |
---|---|
Provider Name | Mr. Kraig William Leiby |
First Address | Wyomissing, PA 19610-3220 |
Second Address | Wyomissing, PA 19610-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 26/08/2008 |