MEDICARE: DR. LISA M OSBORNE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070.014142	IL
2	2251P0200X	Pediatric Physical Therapist	070.014142	IL

General Provider Information

NPI Number	:	1558568105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M OSBORNE DPT

Provider Business Mailing Address
First Line	:	2230 W ERIE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1322
Country	:	US
Telephone Number	:	312-330-4783
Fax Number	:	312-284-8868

Provider Business Practice Location Address
First Line	:	2230 W ERIE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1322
Country	:	US
Telephone Number	:	312-330-4783
Fax Number	:	312-284-8868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	03/25/2013

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