Individual
MR. CHARLES RICHARD LEIDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
3141 N MCMULLEN BOOTH RD, CLEARWATER, FL 33761-2035
(727) 723-7735
(727) 726-7696
Mailing address
3141 N MCMULLEN BOOTH RD, CLEARWATER, FL 33761-2035
(727) 723-7735
(727) 726-7696
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT 4918
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT 4918
FLORIDA OT LICENSE
FL
Enumeration date
12/03/2009
Last updated
12/03/2009
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