MEDICARE: LYDIA GEERTRUIDA SAWKA-LEENDERTSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	2496	OR

General Provider Information

NPI Number	:	1730811514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA GEERTRUIDA SAWKA-LEENDERTSE

Provider Business Mailing Address
First Line	:	17185 WARREN CT
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-5472
Country	:	US
Telephone Number	:	503-758-1353
Fax Number	:

Provider Business Practice Location Address
First Line	:	7632 SW DURHAM RD
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224-7584
Country	:	US
Telephone Number	:	503-783-2470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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Directions to “ LYDIA GEERTRUIDA SAWKA-LEENDERTSE ” Practice Location

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