Provider Demographics
NPI:1568646883
Name:LEACH, EDWARD C (LMP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:LEACH
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 27TH PL W
Mailing Address - Street 2:APT 422
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2133
Mailing Address - Country:US
Mailing Address - Phone:206-234-6505
Mailing Address - Fax:
Practice Address - Street 1:1205 2ND AVE
Practice Address - Street 2:SENECA BLDG
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2950
Practice Address - Country:US
Practice Address - Phone:206-467-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021699225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist