Individual
STEPHEN MICHEAL LEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
147 SW SHEVLIN HIXON DR, SUITE 104, BEND, OR 97702-3130
(541) 312-2252
Mailing address
19570 BALL BUTTE CT, BEND, OR 97702-9148
(541) 312-2252
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
4885
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
840573000
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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