Provider Demographics
NPI:1699004432
Name:CONOPIO, LEILANE RITA MONTECALVO (PT)
Entity Type:Individual
Prefix:
First Name:LEILANE RITA
Middle Name:MONTECALVO
Last Name:CONOPIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEILANE RITA
Other - Middle Name:AYALA
Other - Last Name:MONTECALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1920 OLD SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5858
Mailing Address - Country:US
Mailing Address - Phone:205-520-9600
Mailing Address - Fax:205-520-0455
Practice Address - Street 1:3333 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5884
Practice Address - Country:US
Practice Address - Phone:618-998-7074
Practice Address - Fax:618-998-7515
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002331225100000X
IL070.016809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist