Provider Demographics
NPI:1043094998
Name:LEREAU, ISAIAH (DPT)
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:LEREAU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7719 64TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5515
Mailing Address - Country:US
Mailing Address - Phone:253-651-7411
Mailing Address - Fax:253-651-7411
Practice Address - Street 1:615 S BAKER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2318
Practice Address - Country:US
Practice Address - Phone:253-200-0741
Practice Address - Fax:253-651-7411
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61472736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist