Provider Demographics
NPI:1316113863
Name:AVELLANEDA, LEILANI SARILE (PT)
Entity type:Individual
Prefix:MRS
First Name:LEILANI
Middle Name:SARILE
Last Name:AVELLANEDA
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 1:91 ARIES LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3309
Mailing Address - Country:US
Mailing Address - Phone:541-963-8678
Mailing Address - Fax:
Practice Address - Street 1:91 ARIES LN
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3309
Practice Address - Country:US
Practice Address - Phone:541-963-8678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist