Provider Demographics
NPI:1295430536
Name:NEW LEAF PHYSICAL THERAPY AND WELLNESS PLLC
Entity type:Organization
Organization Name:NEW LEAF PHYSICAL THERAPY AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGAETANI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-447-9696
Mailing Address - Street 1:249 MAIN AVE S STE 107 PMB 204
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-5016
Mailing Address - Country:US
Mailing Address - Phone:425-793-2017
Mailing Address - Fax:425-490-6810
Practice Address - Street 1:35003 SE TERRACE ST
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5039
Practice Address - Country:US
Practice Address - Phone:425-793-2017
Practice Address - Fax:425-490-6810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty