Provider Demographics
NPI:1245901925
Name:LEONTIOS, TAYLOR MCDERMOTT (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:MCDERMOTT
Last Name:LEONTIOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ELIZABETH
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 PATRICIA ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9295
Mailing Address - Country:US
Mailing Address - Phone:309-232-7589
Mailing Address - Fax:
Practice Address - Street 1:813 PATRICIA ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9295
Practice Address - Country:US
Practice Address - Phone:309-232-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist