Provider Demographics
NPI:1740697135
Name:LEIDNER, RONALD III
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:LEIDNER
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RONNIE
Other - Middle Name:J
Other - Last Name:LEIDNER
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MAT,ATC,LAT
Mailing Address - Street 1:3520 YALE DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8774
Mailing Address - Country:US
Mailing Address - Phone:719-641-5200
Mailing Address - Fax:
Practice Address - Street 1:5101 E MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-4630
Practice Address - Country:US
Practice Address - Phone:940-369-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT50492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer