Provider Demographics
NPI:1467422931
Name:LEININGER, PETER M (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:LEININGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:5886 VENTURE PARK DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1848
Practice Address - Country:US
Practice Address - Phone:269-375-4737
Practice Address - Fax:269-375-4747
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302534225100000X
PAPT012839L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA579950OtherHIGHMARK BLUE SHIELD
PA01816976Medicaid
PA824632OtherFIRST PRIORITY HEALTH
PA579950OtherHIGHMARK BLUE SHIELD