Provider Demographics
NPI:1386787059
Name:DE LEPPER, PIETER ALBERT (PT, OCS, CERT MDT)
Entity type:Individual
Prefix:
First Name:PIETER
Middle Name:ALBERT
Last Name:DE LEPPER
Suffix:
Gender:M
Credentials:PT, OCS, CERT MDT
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:
Other - Last Name:DE LEPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:40 2ND ST E
Mailing Address - Street 2:SUITE 222
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6110
Mailing Address - Country:US
Mailing Address - Phone:406-257-8250
Mailing Address - Fax:406-257-8253
Practice Address - Street 1:40 2ND ST E
Practice Address - Street 2:SUITE 222
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6110
Practice Address - Country:US
Practice Address - Phone:406-257-8250
Practice Address - Fax:406-257-8253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3400007Medicaid