Individual
BENEDICT IANE ROQUE LUSUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 ROOSEVELT PL UNIT A, VALPARAISO, IN 46383-3707
(219) 548-4663
(219) 477-5920
Mailing address
1200 ROOSEVELT PL UNIT A, VALPARAISO, IN 46383-3707
(219) 548-4663
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05013907A
IN
Other
Enumeration date
09/15/2020
Last updated
11/10/2020
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