Provider Demographics
NPI:1306519608
Name:LENARD, ELISHA NICOLE
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:NICOLE
Last Name:LENARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 MACEDONIA RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62890-2915
Mailing Address - Country:US
Mailing Address - Phone:618-308-0667
Mailing Address - Fax:
Practice Address - Street 1:210 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:ENERGY
Practice Address - State:IL
Practice Address - Zip Code:62933-3568
Practice Address - Country:US
Practice Address - Phone:618-942-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160.007955OtherPTA LICENSE