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Individual

MRS. EVE WINONA LEDESMA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
2750 NW HARRISON BLVD, CORVALLIS, OR 97330-5208
(541) 768-4000
Mailing address
315 VINCENT ST, PHILOMATH, OR 97370-9219
(541) 929-2156

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5346
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
274085
OREGON STATE DMAP
OR
Enumeration date
08/06/2007
Last updated
08/06/2007
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