MEDICARE: MARGARET L LEISE PT

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
1	225100000X	Physical Therapist	070012199	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00931599	OTHER	IL	MEDICARE RAILROAD
2	P00852545	OTHER	IL	MEDICARE RR

General Provider Information

NPI Number	:	1053404368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET L LEISE PT

Provider Business Mailing Address
First Line	:	24520 S US HIGHWAY 52 UNIT 2
Second Line	:
City	:	MANHATTAN
State	:	IL
Zip	:	60442-7784
Country	:	US
Telephone Number	:	815-242-0878
Fax Number	:	779-379-1300

Provider Business Practice Location Address
First Line	:	24520 S US HIGHWAY 52 UNIT 2
Second Line	:
City	:	MANHATTAN
State	:	IL
Zip	:	60442-7784
Country	:	US
Telephone Number	:	815-242-0878
Fax Number	:	779-379-1300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	12/30/2025

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Directions to “ MARGARET L LEISE PT” Practice Location

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