Provider Demographics
NPI:1841750411
Name:CRAWL WALK LEAP P.C.
Entity Type:Organization
Organization Name:CRAWL WALK LEAP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIENKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-243-3491
Mailing Address - Street 1:720 W RANDOLPH ST APT 1103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2171
Mailing Address - Country:US
Mailing Address - Phone:414-243-3491
Mailing Address - Fax:
Practice Address - Street 1:720 W RANDOLPH ST APT 1103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2171
Practice Address - Country:US
Practice Address - Phone:414-243-3491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty