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) 789-8962
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
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
070021814
IL
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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