Provider Demographics
NPI:1457019994
Name:LENIHAN, CONNOR P (PTA)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:P
Last Name:LENIHAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 N 210TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5141
Mailing Address - Country:US
Mailing Address - Phone:402-740-6175
Mailing Address - Fax:
Practice Address - Street 1:7395 W EASTMAN PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5006
Practice Address - Country:US
Practice Address - Phone:303-730-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1374225200000X
COCP008788A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant