Active NPI
Leslie Ivy
- Physical Therapy Assistant
- Chicago, IL
National Provider Identifier
1558707000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160006365
- Practice address
- 12215 South Lasalle St.
Chicago, IL 60628-9021 - Phone
- (773) 443-2770
- NPI assigned
- May 10, 2013
- Last updated
- May 10, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160006365 | IL | Primary |
Addresses
Primary practice location
12215 South Lasalle St.
Chicago, IL 60628-9021
Mailing address
12215 South Lasalle St.
Chicago, IL 60628-9021
Phone (773) 443-2770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160006365 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368144000000",
"number": "1558707000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12215 SOUTH LASALLE ST.",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606289021",
"telephone_number": "773-443-2770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12215 SOUTH LASALLE ST.",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606289021",
"telephone_number": "773-443-2770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVY",
"first_name": "LESLIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-10",
"last_updated": "2013-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160006365",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.