Provider Demographics
NPI:1558713271
Name:LEITH, EVAN PIERCE (PT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:PIERCE
Last Name:LEITH
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 1:2208 W 8TH ST APT 225
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5046
Mailing Address - Country:US
Mailing Address - Phone:424-400-4671
Mailing Address - Fax:
Practice Address - Street 1:427 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1409
Practice Address - Country:US
Practice Address - Phone:310-656-8600
Practice Address - Fax:310-656-8606
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48024225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant