Provider Demographics
NPI:1174970248
Name:LEER, KAYLA (DPT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LEER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 43RD ST S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8908
Mailing Address - Country:US
Mailing Address - Phone:701-277-8448
Mailing Address - Fax:701-277-8668
Practice Address - Street 1:1560 S CAROL ST
Practice Address - Street 2:SUITE 150
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1839
Practice Address - Country:US
Practice Address - Phone:208-287-9420
Practice Address - Fax:208-287-9426
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDPT-1937OtherND STATE LICENSE