Provider Demographics
NPI:1881450369
Name:BAEDER, LESLIE ANN (PT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:BAEDER
Suffix:
Gender:F
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:PO BOX 2264
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-2264
Mailing Address - Country:US
Mailing Address - Phone:970-209-1921
Mailing Address - Fax:
Practice Address - Street 1:611 E STAR CT STE B
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6704
Practice Address - Country:US
Practice Address - Phone:970-249-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist