Individual
LISA MARIE KENNEDY-LEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1441 SW CHANDLER AVE, SUITE 103, BEND, OR 97702-3221
(541) 312-2252
Mailing address
1118 SE TEAKWOOD DR, BEND, OR 97702-2303
(541) 382-5515
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2477
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
840574002
BLUE CROSS PIN
OR
01
—
J6507-02
PACIFIC SOURCE PIN
OR
Enumeration date
05/02/2007
Last updated
03/08/2013
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