Provider Demographics
NPI:1033959440
Name:LEDDY, DAVID
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LEDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38103 112TH AVE E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328
Mailing Address - Country:US
Mailing Address - Phone:847-529-8574
Mailing Address - Fax:
Practice Address - Street 1:5602 176TH ST E STE G102103
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9307
Practice Address - Country:US
Practice Address - Phone:253-847-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60401854225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist