Healthcare Provider Details

I. General information

NPI: 1902839467
Provider Name (Legal Business Name): CLIFFORD JAMES LEDUC P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11392 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9001
US

IV. Provider business mailing address

11392 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9001
US

V. Phone/Fax

Practice location:
  • Phone: 530-432-9660
  • Fax: 530-432-9663
Mailing address:
  • Phone: 530-432-9660
  • Fax: 530-432-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT12819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: