Healthcare Provider Details

I. General information

NPI: 1508016411
Provider Name (Legal Business Name): LEAH KATHRYN WILSON PT, CMC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH KATHRYN WILSON PT, CMC

II. Dates (important events)

Enumeration Date: 09/27/2008
Last Update Date: 09/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 N 82ND ST
SEATTLE WA
98103-4322
US

IV. Provider business mailing address

916 N 82ND ST
SEATTLE WA
98103-4322
US

V. Phone/Fax

Practice location:
  • Phone: 206-428-1964
  • Fax: 206-428-1964
Mailing address:
  • Phone: 206-428-1964
  • Fax: 206-428-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT00009689
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: