MEDICARE: ANDREIA LEON 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	070015342	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	568080	OTHER	IL	MEDICARE GROUP NUMBER
3	CJ4383	OTHER	IL	R.R. MEDICARE GRP #
5	568150	OTHER	IL	MEDICARE GROUP NUMBER
7	567700	OTHER	IL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619908	OTHER	IL	BCBS IL GROUP NUMBER
4	367885100	OTHER	IL	US DEPT OF LABOR PROV #
6	1623066	OTHER	IL	BCBS PROVIDER #

General Provider Information

NPI Number	:	1154413870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREIA LEON PT

Provider Business Mailing Address
First Line	:	205 W WACKER DR
Second Line	:	SUITE 1020
City	:	CHICAGO
State	:	IL
Zip	:	60606-1216
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	8658 S COTTAGE GROVE AVE
Second Line	:	UNIT 400
City	:	CHICAGO
State	:	IL
Zip	:	60619-6186
Country	:	US
Telephone Number	:	773-723-1270
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/06/2015

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Directions to “ ANDREIA LEON PT” Practice Location

Language	Start Address	Practice Location

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