Provider Demographics
NPI:1437661196
Name:STRAUB, LEAH MARIE WHEATON (ATC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE WHEATON
Last Name:STRAUB
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-3754
Mailing Address - Country:US
Mailing Address - Phone:360-509-8330
Mailing Address - Fax:
Practice Address - Street 1:17001 TESTER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2896
Practice Address - Country:US
Practice Address - Phone:360-804-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20000297892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000029789OtherBOC NUMBER