Provider Demographics
NPI:1699952812
Name:KAYSER, LEILA IMOGENE (LMT)
Entity type:Individual
Prefix:MS
First Name:LEILA
Middle Name:IMOGENE
Last Name:KAYSER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4901
Mailing Address - Country:US
Mailing Address - Phone:779-423-1700
Mailing Address - Fax:866-596-1207
Practice Address - Street 1:101 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4901
Practice Address - Country:US
Practice Address - Phone:779-423-1700
Practice Address - Fax:866-596-1207
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.003938174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist