Healthcare Provider Details

I. General information

NPI: 1346135316
Provider Name (Legal Business Name): ISABELLA CHRISTINE LEEDHAM PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 N CLYBOURN AVE # LEVEL3
CHICAGO IL
60614-3193
US

IV. Provider business mailing address

1415 W AUGUSTA BLVD BSMT
CHICAGO IL
60642-3941
US

V. Phone/Fax

Practice location:
  • Phone: 773-377-5492
  • Fax:
Mailing address:
  • Phone: 913-961-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number070029197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: