Provider Demographics
NPI:1730223405
Name:LEIDIG, PETER K (PT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:LEIDIG
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 1:22310 34TH PL W
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8058
Mailing Address - Country:US
Mailing Address - Phone:206-320-3273
Mailing Address - Fax:
Practice Address - Street 1:1600 E JEFFERSON ST STE A5
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5656
Practice Address - Country:US
Practice Address - Phone:206-320-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist