Provider Demographics
NPI:1558599340
Name:LEITZ, ISAAC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:LEITZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 E HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-9663
Mailing Address - Country:US
Mailing Address - Phone:425-281-1280
Mailing Address - Fax:
Practice Address - Street 1:5575 N HARBOR AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249
Practice Address - Country:US
Practice Address - Phone:360-331-0141
Practice Address - Fax:360-331-0142
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60093533225100000X
AK2329225100000X
NM3963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006236Medicaid
WA2006236Medicaid