Provider Demographics
NPI:1639250954
Name:HALKOVICH, LEO ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:ROBERT
Last Name:HALKOVICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 S FRONTAGE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5830
Mailing Address - Country:US
Mailing Address - Phone:630-920-4670
Mailing Address - Fax:630-920-4689
Practice Address - Street 1:1850 W WINCHESTER RD
Practice Address - Street 2:SUITE 223
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5357
Practice Address - Country:US
Practice Address - Phone:847-680-3020
Practice Address - Fax:847-680-3077
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist