Individual
LEESA D NYSTROM
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
924 S RIVERSIDE AVE, MEDFORD, OR 97501-7842
(541) 773-7678
(541) 773-5517
Mailing address
924 S RIVERSIDE AVE, MEDFORD, OR 97501-7842
(541) 773-7678
(541) 773-5517
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0775
OR
Other
Enumeration date
07/22/2005
Last updated
07/08/2007
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