Provider Demographics
NPI:1134350200
Name:LEANO-LAXAMANA, CRISNA (PT)
Entity type:Individual
Prefix:
First Name:CRISNA
Middle Name:
Last Name:LEANO-LAXAMANA
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 1:9150 E109TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8674
Mailing Address - Country:US
Mailing Address - Phone:219-310-8584
Mailing Address - Fax:219-310-8685
Practice Address - Street 1:9150 E109TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8674
Practice Address - Country:US
Practice Address - Phone:219-310-8584
Practice Address - Fax:219-310-8685
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004718A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist