Provider Demographics
NPI:1972340636
Name:KERN, LEAH MICHELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:KERN
Suffix:
Gender:F
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 1:7638 WINONA AVE N # A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4840
Mailing Address - Country:US
Mailing Address - Phone:630-696-2906
Mailing Address - Fax:
Practice Address - Street 1:1500 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2338
Practice Address - Country:US
Practice Address - Phone:206-735-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16859-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist