Provider Demographics
NPI:1194287714
Name:LUEDERS, TONJA A (MED, LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:TONJA
Middle Name:A
Last Name:LUEDERS
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 SE DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1432
Mailing Address - Country:US
Mailing Address - Phone:503-867-5083
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS WAY
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85287-0001
Practice Address - Country:US
Practice Address - Phone:480-965-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0015712255A2300X
ORAT-102001492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer