Provider Demographics
NPI:1255414488
Name:FERRIGAN, LESLIE D (PT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:FERRIGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:G
Other - Last Name:DACANAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:363 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-3036
Mailing Address - Country:US
Mailing Address - Phone:847-487-0290
Mailing Address - Fax:847-487-0292
Practice Address - Street 1:363 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-3036
Practice Address - Country:US
Practice Address - Phone:847-487-0290
Practice Address - Fax:847-487-0292
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700059962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL69435Medicare UPIN