Russell Leighty, PT, DPT – Physical Therapist

Key facts

NPI: 1780120154
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: PT60666701 (WA)
Practice address: 55 W Tietan St
Walla Walla, WA 99362-4445
Phone: (509) 525-3720
Fax: (509) 522-1592
NPI assigned: Jan 10, 2017
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Walla Walla Clinic, Inc. Ambulatory Surgical Clinic/Center · Walla Walla, WA · NPI 1760568273

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Walla Walla Clinic, Inc.		Current	Accepting new patients

Locations

55 W Tietan St
Walla Walla, WA 99362
Phone (509) 525-3720

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	PT60666701	WA	Yes

Addresses

Primary practice location

55 W Tietan St
Walla Walla, WA 99362-4445

Mailing address

55 W Tietan St
Walla Walla, WA 99362-4445
Phone (509) 525-3720

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 14, 2023.

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1780120154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445",
            "telephone_number": "509-525-3720",
            "fax_number": "509-522-1592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 W TIETAN ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624445",
            "telephone_number": "509-525-3720",
            "fax_number": "509-522-1592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEIGHTY",
        "first_name": "RUSSELL",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-10",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60666701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

All providers in Walla Walla, WA · Physical Therapist in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.