Provider Demographics
NPI:1588999627
Name:ADAMS, LEAH MARIE (PT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:KUNTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2120 43RD ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3772
Mailing Address - Country:US
Mailing Address - Phone:616-281-1144
Mailing Address - Fax:616-954-6483
Practice Address - Street 1:5819 BALSAM DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1104
Practice Address - Country:US
Practice Address - Phone:616-209-5435
Practice Address - Fax:616-954-6483
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0D14869084Medicare PIN