Healthcare Provider Details

I. General information

NPI: 1033299615
Provider Name (Legal Business Name): LESLIE KAMMES CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE KAMMES

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S ADDISON AVE
VILLA PARK IL
60181-2877
US

IV. Provider business mailing address

830 S ADDISON AVE
VILLA PARK IL
60181-2877
US

V. Phone/Fax

Practice location:
  • Phone: 630-620-4433
  • Fax: 630-620-1148
Mailing address:
  • Phone: 630-620-4433
  • Fax: 630-620-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: