Provider Demographics
NPI:1164424206
Name:LEON, ANNETTE P (PT)
Entity Type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:P
Last Name:LEON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT, DPT
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:630-759-9510
Practice Address - Street 1:3175 SAINT ROSE PKWY
Practice Address - Street 2:STE 331
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3506
Practice Address - Country:US
Practice Address - Phone:702-474-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT 287010OtherBLUE SHIELD
CAWPT28701AMedicare ID - Type Unspecified