| Doctor Name: | KEVIN ALAN LEISEBERG |
| NPI Number: | 1093827685 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, PT |
| License Number: | 070-011208 |
| Business Practice Address: | 300 S State St Marengo, IL - 601523532 |
| Business Phone Number: | 8155684550 |
| Business Fax Number: | 8155685071 |
| Mailing Address: | 625 Enterprise Dr, OAK BROOK |
| State: | IL |
| Postal Code: | 605238813 |
| Phone Number: | 6305751980 |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 04/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070-011208 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |