Provider Demographics
NPI:1548449200
Name:LEESMAN, KRISTIN N (PT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:LEESMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:N
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1005
Mailing Address - Country:US
Mailing Address - Phone:306-672-4568
Mailing Address - Fax:309-672-4569
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE 450
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1005
Practice Address - Country:US
Practice Address - Phone:306-672-4568
Practice Address - Fax:309-672-4569
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist