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General NPI Number Information
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NPI Number | 1184014292
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Entity Type | Individual
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Provider Name | LISA LASZCZAK
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Gender | Female
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 605 EDWARD DR
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City | ROMEOVILLE
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State | IL
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Zip | 60446-6507
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Country | US
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Telephone | 815-556-2487
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Fax |
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Provider Business Mailing Address
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Address Line | 9023 LUNAR AVE APT 204
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City | ORLAND PARK
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State | IL
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Zip | 60462-3329
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Country | US
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Telephone | 815-277-7547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160006380
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License Number State | IL
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