Provider Demographics
NPI:1871193466
Name:LEAKE, KATHRYN ERNST (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ERNST
Last Name:LEAKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MAE
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4230
Mailing Address - Country:US
Mailing Address - Phone:504-309-6500
Mailing Address - Fax:504-309-6585
Practice Address - Street 1:3600 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4230
Practice Address - Country:US
Practice Address - Phone:504-309-6500
Practice Address - Fax:504-309-6585
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist