Active NPI
Leslie Kanak, PT
- Physical Therapist
- New Baden, IL
National Provider Identifier
1659699270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070016337
- Practice address
- 211 E Hanover St
New Baden, IL 62265-1811 - Phone
- (618) 234-9705
- Fax
- (618) 257-0665
- NPI assigned
- May 6, 2010
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225100000X | 070016337 | IL | Primary |
Addresses
Primary practice location
211 E Hanover St
New Baden, IL 62265-1811
Mailing address
211 E Hanover St
New Baden, IL 62265-1811
Phone (618) 234-9705
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00891171 | Other | IL | RR MEDICARE PTAN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070016337 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306454400000",
"number": "1659699270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 E HANOVER ST",
"city": "NEW BADEN",
"state": "IL",
"postal_code": "622651811",
"telephone_number": "618-234-9705",
"fax_number": "618-257-0665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 E HANOVER ST",
"city": "NEW BADEN",
"state": "IL",
"postal_code": "622651811",
"telephone_number": "618-234-9705",
"fax_number": "618-257-0665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANAK",
"first_name": "LESLIE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-06",
"last_updated": "2011-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070016337",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PTAN",
"identifier": "P00891171",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Baden, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.