Healthcare Provider Details

I. General information

NPI: 1679787717
Provider Name (Legal Business Name): CYNTHHIA JO LEDERMAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 26TH AVE
MONROE WI
53566-1531
US

IV. Provider business mailing address

345 URBAN RD
MONTICELLO WI
53570-9637
US

V. Phone/Fax

Practice location:
  • Phone: 608-329-6600
  • Fax: 608-329-6594
Mailing address:
  • Phone: 608-938-4645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2162-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: