Healthcare Provider Details

I. General information

NPI: 1356055255
Provider Name (Legal Business Name): CONNER LEIDING PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 16TH ST
BURLINGTON CO
80807-1649
US

IV. Provider business mailing address

1254 2ND AVE
VONA CO
80861-5003
US

V. Phone/Fax

Practice location:
  • Phone: 719-346-0366
  • Fax:
Mailing address:
  • Phone: 719-751-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTL.0018869
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: