Provider Demographics
NPI:1881351500
Name:LEONARD, KATARINA EVE
Entity type:Individual
Prefix:
First Name:KATARINA
Middle Name:EVE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATARINA
Other - Middle Name:EVE
Other - Last Name:DYMOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1150 N ELKHORN DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6392
Mailing Address - Country:US
Mailing Address - Phone:907-841-0386
Mailing Address - Fax:
Practice Address - Street 1:35249 KENAI SPUR HWY STE C
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7673
Practice Address - Country:US
Practice Address - Phone:907-420-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant