Provider Demographics
NPI:1528268406
Name:BIRD, LEENA (PT)
Entity type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEENA
Other - Middle Name:
Other - Last Name:ANTURKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:2940 ROLLINGRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4231
Practice Address - Country:US
Practice Address - Phone:630-527-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931629OtherMEDICARE RAILROAD
ILP00852574OtherMEDICARE RAILROAD
ILK40113Medicare PIN
IL212622014Medicare PIN
IL202845115Medicare PIN
IL213392007Medicare PIN