Provider Demographics
NPI:1154413870
Name:LEON, ANDREIA (PT)
Entity type:Individual
Prefix:
First Name:ANDREIA
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANDREIA
Other - Middle Name:L
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:8658 S COTTAGE GROVE AVE
Practice Address - Street 2:UNIT 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6186
Practice Address - Country:US
Practice Address - Phone:773-723-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
ILCJ4383OtherR.R. MEDICARE GRP #
IL367885100OtherUS DEPT OF LABOR PROV #
IL568150OtherMEDICARE GROUP NUMBER
IL1623066OtherBCBS PROVIDER #
IL567700OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
ILR02020Medicare PIN
ILCJ4383OtherR.R. MEDICARE GRP #
IL367885100OtherUS DEPT OF LABOR PROV #
ILR02019Medicare PIN