Active NPI
Marisa Jean Leykam, P.T.
- Physical Therapist
- Boulder, CO
National Provider Identifier
1104019173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7844
- Practice address
- 1055 Adams Cir
Boulder, CO 80303-1820 - Phone
- (303) 939-0591
- Fax
- (303) 939-0883
- NPI assigned
- Aug 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7844 | CO | Primary |
Addresses
Primary practice location
1055 Adams Cir
Boulder, CO 80303-1820
Mailing address
1055 Adams Cir
Boulder, CO 80303-1820
Phone (303) 939-0591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7844 | CO | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187827200000",
"number": "1104019173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 ADAMS CIR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803031820",
"telephone_number": "303-939-0591",
"fax_number": "303-939-0883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 ADAMS CIR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803031820",
"telephone_number": "303-939-0591",
"fax_number": "303-939-0883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEYKAM",
"first_name": "MARISA",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-23",
"last_updated": "2007-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "7844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.