Healthcare Provider Details

I. General information

NPI: 1053275503
Provider Name (Legal Business Name): NATHAN LEYDIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 FOWLER RD
WEXFORD PA
15090
US

IV. Provider business mailing address

40 W MANILLA AVE
PITTSBURGH PA
15220-2838
US

V. Phone/Fax

Practice location:
  • Phone: 724-799-8263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC020189
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: