Provider Demographics
NPI:1013939677
Name:PELDYAK SCHMIDT, LEAH (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:PELDYAK SCHMIDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:JEANNE
Other - Last Name:PELDYAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:495 STATE ST FL 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 W C ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1458
Practice Address - Country:US
Practice Address - Phone:503-873-6111
Practice Address - Fax:503-873-6113
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR103149Medicare PIN