Provider Demographics
NPI:1063137560
Name:LION CONCIERGE PHYSICAL THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:LION CONCIERGE PHYSICAL THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEONTIOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:309-232-7589
Mailing Address - Street 1:813 PATRICIA ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9295
Mailing Address - Country:US
Mailing Address - Phone:309-232-7589
Mailing Address - Fax:
Practice Address - Street 1:813 PATRICIA ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9295
Practice Address - Country:US
Practice Address - Phone:309-222-0489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty