Provider Demographics
NPI:1508016411
Name:WILSON, LEAH KATHRYN (PT, CMC)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:KATHRYN
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT, CMC
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:KATHRYN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, CMC
Mailing Address - Street 1:916 N 82ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4322
Mailing Address - Country:US
Mailing Address - Phone:206-428-1964
Mailing Address - Fax:206-428-1964
Practice Address - Street 1:916 N 82ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4322
Practice Address - Country:US
Practice Address - Phone:206-428-1964
Practice Address - Fax:206-428-1964
Is Sole Proprietor?:No
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000096892251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics