Healthcare Provider Details

I. General information

NPI: 1780754663
Provider Name (Legal Business Name): THERESA M LEDBETTER DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 W MARGARET ST
PASCO WA
99301-4127
US

IV. Provider business mailing address

704 W MARGARET
PASCO WA
99301
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-5906
  • Fax: 509-547-5999
Mailing address:
  • Phone: 509-545-5906
  • Fax: 509-547-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDP00140
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. THERESA MARIE LEDBETTER CHEN
Title or Position: PRESIDENT
Credential: DPM
Phone: 509-545-5906