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Organization
LEONARD WANTA SC
Active
Organization
LEONARD WANTA SC
Active
Other names
Distinctive Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD WANTA PT (PRESIDENT)
(630) 915-6813
Entity
Organization
Contact information
Practice address
126 CIRCLE RIDGE DR, BURR RIDGE, IL 60527-8379
(630) 789-8962
(630) 654-3088
Mailing address
126 CIRCLE RIDGE DR, BURR RIDGE, IL 60527-8379
(630) 789-8962
(630) 654-3088
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
070003801
IL
Other
Enumeration date
10/22/2013
Last updated
10/22/2013
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