MEDICARE: AMADEO ESEQUIEL LEDESMA PT

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	1321266	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8LN865	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1750937389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMADEO ESEQUIEL LEDESMA PT

Provider Business Mailing Address
First Line	:	2431 S LOOP 289
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-1519
Country	:	US
Telephone Number	:	806-771-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	6017 HILLSIDE RD STE 1100
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-7213
Country	:	US
Telephone Number	:	806-680-5888
Fax Number	:

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

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	03/13/2023

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