Provider Demographics
NPI:1730344201
Name:LEADING EDGE, INC
Entity type:Organization
Organization Name:LEADING EDGE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARTELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-315-3603
Mailing Address - Street 1:11336 S 96TH ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4286
Mailing Address - Country:US
Mailing Address - Phone:402-315-3603
Mailing Address - Fax:402-315-3604
Practice Address - Street 1:11336 S 96TH ST
Practice Address - Street 2:SUITE 114
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4286
Practice Address - Country:US
Practice Address - Phone:402-315-3603
Practice Address - Fax:402-315-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025656400Medicaid
NE10025656400Medicaid