Basic Information
Provider Information
NPI: 1669674727
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KARKHANIS
FirstName: LEENA
MiddleName: A
NamePrefix: MRS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1952 ABERDEEN CT
Address2:  
City: SYCAMORE
State: IL
PostalCode: 601783175
CountryCode: US
TelephoneNumber: 8157580000
FaxNumber: 8157483014
Practice Location
Address1: 1513 DEKALB AVE
Address2:  
City: SYCAMORE
State: IL
PostalCode: 601782703
CountryCode: US
TelephoneNumber: 8157580000
FaxNumber: 8159919484
Other Information
ProviderEnumerationDate: 06/01/2007
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X070-007799ILN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
2251X0800X070-007799ILY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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