Provider Demographics
NPI:1891552923
Name:CAMMACK, LEAH REBEKAH (LMT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:REBEKAH
Last Name:CAMMACK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 EVERGLADES CT
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1320
Mailing Address - Country:US
Mailing Address - Phone:253-310-6961
Mailing Address - Fax:
Practice Address - Street 1:1503 W STEWART
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5149
Practice Address - Country:US
Practice Address - Phone:253-848-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist