Provider Demographics
NPI:1225254162
Name:LEDDY, PATRICIA
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:
Last Name:LEDDY
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 1:4714 147TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2527
Mailing Address - Country:US
Mailing Address - Phone:708-385-5736
Mailing Address - Fax:708-385-5754
Practice Address - Street 1:4714 147TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2527
Practice Address - Country:US
Practice Address - Phone:708-385-5736
Practice Address - Fax:708-385-5754
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL316743311744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4313710001Medicare NSC