Provider Demographics
NPI:1205462892
Name:LEITHAUSER, KEVIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LEITHAUSER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4704
Mailing Address - Country:US
Mailing Address - Phone:201-245-4573
Mailing Address - Fax:
Practice Address - Street 1:119 E PASSAIC ST
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1342
Practice Address - Country:US
Practice Address - Phone:201-880-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01917400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist