Provider Demographics
NPI:1467039073
Name:LEATHERMAN, JOHN QUINT
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:QUINT
Last Name:LEATHERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NE THORNTON PL # 358732
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8021
Mailing Address - Country:US
Mailing Address - Phone:206-520-2405
Mailing Address - Fax:
Practice Address - Street 1:105 S APPLE BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-8810
Practice Address - Country:US
Practice Address - Phone:509-682-6000
Practice Address - Fax:509-682-6296
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program