Provider Demographics
NPI:1215136924
Name:PAGENKOPF, LEAH (MPT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:PAGENKOPF
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 GLACIER HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8079
Mailing Address - Country:US
Mailing Address - Phone:907-723-5781
Mailing Address - Fax:907-789-0793
Practice Address - Street 1:8800 GLACIER HWY STE 108
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8079
Practice Address - Country:US
Practice Address - Phone:907-723-5781
Practice Address - Fax:907-789-0793
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK$$$$$$$$$OtherSS#
AK151145Medicare PIN
AK$$$$$$$$$OtherSS#