Provider Demographics
NPI:1821261447
Name:LEDESMA, IMEE (PT)
Entity Type:Individual
Prefix:
First Name:IMEE
Middle Name:
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 26TH ST W
Mailing Address - Street 2:1115
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-7200
Mailing Address - Country:US
Mailing Address - Phone:347-922-0866
Mailing Address - Fax:
Practice Address - Street 1:3101 37TH AVE N
Practice Address - Street 2:SUITE A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-1509
Practice Address - Country:US
Practice Address - Phone:727-328-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist