Provider Demographics
NPI:1356055255
Name:LEIDING, CONNER (PT, DPT)
Entity type:Individual
Prefix:
First Name:CONNER
Middle Name:
Last Name:LEIDING
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:VONA
Mailing Address - State:CO
Mailing Address - Zip Code:80861-5003
Mailing Address - Country:US
Mailing Address - Phone:719-751-3311
Mailing Address - Fax:
Practice Address - Street 1:182 16TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1649
Practice Address - Country:US
Practice Address - Phone:719-346-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018869261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy