Healthcare Provider Details

I. General information

NPI: 1982567152
Provider Name (Legal Business Name): LESLIE DONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 GOODPASTURE ISLAND RD
EUGENE OR
97401-1774
US

IV. Provider business mailing address

3330 SE THREE MILE LN
MCMINNVILLE OR
97128-6232
US

V. Phone/Fax

Practice location:
  • Phone: 541-246-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9837
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: