MEDICARE: MS. LIBILY LUKOSE PT

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	070012382	IL

General Provider Information

NPI Number	:	1750540027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIBILY LUKOSE PT

Provider Business Mailing Address
First Line	:	9745 S KARLOV AVE
Second Line	:	307
City	:	OAK LAWN
State	:	IL
Zip	:	60453-3389
Country	:	US
Telephone Number	:	708-423-8867
Fax Number	:

Provider Business Practice Location Address
First Line	:	9745 SOUTH KARLOV AVE
Second Line	:	307
City	:	OAKLAWN
State	:	IL
Zip	:	60453
Country	:	US
Telephone Number	:	708-423-8869
Fax Number	:

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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