Provider Demographics
NPI:1326162439
Name:LEEK, MARK L (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:LEEK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:360-454-1900
Mailing Address - Fax:360-454-1991
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:360-454-1900
Practice Address - Fax:360-454-1991
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010397174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8494783OtherDSHS
WA0229756OtherL&I
WA3388LEOtherREGENCE BS
WA5677LEOtherREGENCE BS
WA8871179OtherMEDICARE
WA8946493OtherL&I CRIME
WA0229758OtherL&I
WA3347LEOtherREGENCE BS
WA7661LEOtherREGENCE BS
WAP00739007OtherRAILROAD MEDICARE
WA1043745Medicaid
WA8871180OtherMEDICARE
WA9411LEOtherREGENCE BS
WA8871180OtherMEDICARE