Provider Demographics
NPI:1609805076
Name:LEAHY, KATHLEEN C (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:C
Last Name:LEAHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6928
Mailing Address - Country:US
Mailing Address - Phone:603-644-5133
Mailing Address - Fax:
Practice Address - Street 1:9 WASHINGTON PL STE 201
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6750
Practice Address - Country:US
Practice Address - Phone:603-644-5133
Practice Address - Fax:603-644-3086
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9776208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009687Medicaid
NH30009687Medicaid
NH1609805076Medicare NSC
NHEX6349Medicare PIN