Provider Demographics
NPI:1982239653
Name:LEYDIG, LISA J (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:LEYDIG
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 1:211 W 33RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3485
Mailing Address - Country:US
Mailing Address - Phone:308-236-5884
Mailing Address - Fax:308-236-9621
Practice Address - Street 1:211 W 33RD ST STE A
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3485
Practice Address - Country:US
Practice Address - Phone:308-236-5884
Practice Address - Fax:308-236-9621
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist