Provider Demographics
NPI:1922839091
Name:KINGSBURY, LEIGH MARIE
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:MARIE
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:MARIE
Other - Last Name:MOFFETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3911 E 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3890 UNIVERSITY LAKE DR STE 110
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4669
Practice Address - Country:US
Practice Address - Phone:907-341-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK187996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist