Provider Demographics
NPI:1942680822
Name:LEDERER, ABBY
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:LEDERER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 S ALDER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7318
Mailing Address - Country:US
Mailing Address - Phone:602-456-1443
Mailing Address - Fax:
Practice Address - Street 1:4645 S LAKESHORE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7151
Practice Address - Country:US
Practice Address - Phone:602-456-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-13373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist