Provider Demographics
NPI:1285960807
Name:LEADING EDGE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:LEADING EDGE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEED
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:308-237-7388
Mailing Address - Street 1:7280 LAGAE RD STE F
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9454
Mailing Address - Country:US
Mailing Address - Phone:303-663-5552
Mailing Address - Fax:303-663-5554
Practice Address - Street 1:7280 LAGAE RD STE F
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-9454
Practice Address - Country:US
Practice Address - Phone:303-663-5552
Practice Address - Fax:303-663-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty