Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070.024754 | IL |
N | 2251P0200X | Physical Therapist - Pediatrics | 070.024754 | IL |
NPI | 1063062289 |
---|---|
Provider Name | Dr. Grant P Lehman |
First Address | Galena, IL 61036-8200 |
Second Address | Villa Park, IL 60181-2877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2019 |
Last Update Date | 01/10/2019 |