Individual
LESLIE IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12215 SOUTH LASALLE ST., CHICAGO, IL 60628-9021
(773) 443-2770
Mailing address
12215 SOUTH LASALLE ST., CHICAGO, IL 60628-9021
(773) 443-2770
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160006365
IL
Other
Enumeration date
05/10/2013
Last updated
05/10/2013
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