Provider Demographics
NPI:1427196203
Name:LEUNG, AVIS NGA (PT)
Entity Type:Individual
Prefix:MS
First Name:AVIS
Middle Name:NGA
Last Name:LEUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 PLAINFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5385
Mailing Address - Country:US
Mailing Address - Phone:630-828-3824
Mailing Address - Fax:844-364-8539
Practice Address - Street 1:621 PLAINFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5385
Practice Address - Country:US
Practice Address - Phone:630-828-3824
Practice Address - Fax:844-364-8539
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700064192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25366Medicare PIN
ILK25366Medicare PIN