Provider Demographics
NPI:1548667413
Name:LESNIAK, CORY ANDREW (ATC)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:ANDREW
Last Name:LESNIAK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 N ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60112-4100
Mailing Address - Country:US
Mailing Address - Phone:815-762-2440
Mailing Address - Fax:
Practice Address - Street 1:178 N ASPEN DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:IL
Practice Address - Zip Code:60112-4100
Practice Address - Country:US
Practice Address - Phone:815-762-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0035832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer