Provider Demographics
NPI:1407104318
Name:LEONCIO, ANGELICA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:LEONCIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:LEONCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5980 W 71ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1785
Mailing Address - Country:US
Mailing Address - Phone:317-388-0800
Mailing Address - Fax:317-388-0805
Practice Address - Street 1:8140 MCCORMICK BLVD # 141
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2920
Practice Address - Country:US
Practice Address - Phone:847-750-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.398617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist