Provider Demographics
NPI:1730811514
Name:SAWKA-LEENDERTSE, LYDIA GEERTRUIDA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:GEERTRUIDA
Last Name:SAWKA-LEENDERTSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17185 WARREN CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5472
Mailing Address - Country:US
Mailing Address - Phone:503-758-1353
Mailing Address - Fax:
Practice Address - Street 1:7632 SW DURHAM RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7584
Practice Address - Country:US
Practice Address - Phone:503-783-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OR2496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist