Provider Demographics
NPI:1306157896
Name:LEDESMA SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:LEDESMA SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:912-401-0443
Mailing Address - Street 1:340 EISENHOWER DR BLDG 1400
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1600
Mailing Address - Country:US
Mailing Address - Phone:912-656-2640
Mailing Address - Fax:
Practice Address - Street 1:7010 HODGSON MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2529
Practice Address - Country:US
Practice Address - Phone:912-401-0443
Practice Address - Fax:912-401-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty