Lisa Marie Dejanovich PTA

NPI 1720483134 - Physical Therapy Assistant - 225200000X

NPI Details
NPI 1720483134
Gender Female
Enumeration Date 10/28/2014
Last Updated 10/28/2014
Entity Type Individual
Active Over 2 years ago
Practice Location
13157 S CARONDOLET AVE
CHICAGO IL, 60633-1703, US
Phone (773) 646-4126
Fax
Business Location
13157 S CARONDOLET AVE
CHICAGO IL, 60633-1703, US
Phone (773) 646-4126
Fax
Toxanomy
Taxonomy Code 225200000X
License State Indiana
License Number 06004851A
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According to our database, Lisa Marie Dejanovich PTA NPI is 1720483134, taxonomy code is 225200000X and license number is 06004851A, license state is located at Indiana. Lisa Marie Dejanovich PTA physically located at 13157 S Carondolet Ave, Chicago IL, 60633-1703. NPI Number Lisa Marie Dejanovich PTA has the Individual type.

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1720483134 NPI number is provided on an as is basis without warranty of any kind. 1720483134 is maintained by the National Plan & Provider Enumeration System. The contents of Lisa Marie Dejanovich PTA are for informational purposes only.