Provider Demographics
NPI:1215324835
Name:WHIDBEY PERFORMANCE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:WHIDBEY PERFORMANCE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:425-281-1280
Mailing Address - Street 1:PO BOX 3482
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-3482
Mailing Address - Country:US
Mailing Address - Phone:208-209-6170
Mailing Address - Fax:208-209-6169
Practice Address - Street 1:5575 HARBOR AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-0000
Practice Address - Country:US
Practice Address - Phone:360-331-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty