Healing Walls Rehabilitation LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

070018779 Issued in IL

Legal business name

HEALING WALLS REHABILITATION LLC

Doing business as

Healing Walls Rehabilitation LLC

Practice address

12905 S May St
Calumet Park, IL 60827-6562

Phone

(217) 766-3569

Fax

(708) 842-2004

NPI assigned

Aug 24, 2016

Last updated

Oct 20, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lakecia Shantel Leavy, PT, DPTNPI 1619255650

Title

Owner/Physical Therapist

Phone

(217) 766-3569

Specialties & licenses 1

Addresses

Other names 1

• Healing Walls Rehabilitation LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lakecia Leavy, PT

  • Physical Therapist
  • Chicago, IL
  • NPI 1619255650
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1881149383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12905 S MAY ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276562",
            "telephone_number": "217-766-3569",
            "fax_number": "708-842-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12905 S MAY ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276562",
            "telephone_number": "217-766-3569",
            "fax_number": "708-842-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING WALLS REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-24",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "LEAVY",
        "authorized_official_first_name": "LAKECIA",
        "authorized_official_middle_name": "SHANTEL",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "217-766-3569",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070018779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healing Walls Rehabilitation LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kenyana T Johnson, DEVELOPMENTAL THERAP
• Steven Vernon Johnson Jr., CDL CLASS A

• Physical Therapy Clinic/Center in Calumet Park, IL
• Providers in Calumet Park, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.