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NPI Code Detail

MEDICARE: LESLI LO DPT

MEDICARE: LESLI LO DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistIL

General Provider Information

NPI Number : 1346382959
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLI LO DPT
Provider Business Mailing Address
First Line : 1915 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1618
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1915 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1618
Country : US
Telephone Number : 312-674-9132
Fax Number : 312-674-9392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 07/12/2007

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Directions to “ LESLI LO DPT” Practice Location

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