Provider Demographics
NPI:1942619226
Name:MICHELSEN, LEAH (DPT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MICHELSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27500 102ND AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-9768
Mailing Address - Fax:360-629-6487
Practice Address - Street 1:27500 102ND AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8092
Practice Address - Country:US
Practice Address - Phone:360-629-9768
Practice Address - Fax:360-629-6487
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60476261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist