Provider Demographics
NPI:1699007898
Name:BABARAN, LESGREEN GAMMAD (PT)
Entity Type:Individual
Prefix:MISS
First Name:LESGREEN
Middle Name:GAMMAD
Last Name:BABARAN
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 1:3201 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3440
Mailing Address - Country:US
Mailing Address - Phone:800-886-8108
Mailing Address - Fax:866-422-6431
Practice Address - Street 1:650 E DEVON AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-1251
Practice Address - Country:US
Practice Address - Phone:630-379-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist