Provider Demographics
NPI:1912068941
Name:SAAVEDRA, SANDRA LEE (MS, PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:SAAVEDRA
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 MOSS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1946
Mailing Address - Country:US
Mailing Address - Phone:503-510-9142
Mailing Address - Fax:541-349-0398
Practice Address - Street 1:1763 MOSS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1946
Practice Address - Country:US
Practice Address - Phone:503-510-9142
Practice Address - Fax:541-349-0398
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19532251P0200X
WA000028492251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR047857OtherOMAP
ORS96585Medicare UPIN
OR106117Medicare ID - Type Unspecified