Provider Demographics
NPI:1396210530
Name:LEDDIGE, SARAH DEANNA (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DEANNA
Last Name:LEDDIGE
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E PARKCENTER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6752
Mailing Address - Country:US
Mailing Address - Phone:208-344-2525
Mailing Address - Fax:208-344-3056
Practice Address - Street 1:1175 E PARKCENTER BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6752
Practice Address - Country:US
Practice Address - Phone:208-344-2525
Practice Address - Fax:208-344-3056
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60860927225100000X
IDPT-6412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist