Provider Demographics
NPI:1023504362
Name:SELIGA, LEANNE (PTA)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:SELIGA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 BANBURY AVE
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9059
Mailing Address - Country:US
Mailing Address - Phone:708-691-9687
Mailing Address - Fax:
Practice Address - Street 1:1961 BANBURY AVE
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9059
Practice Address - Country:US
Practice Address - Phone:708-691-9687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004215225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant