Individual
LISA MARIE DEJANOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
13157 S CARONDOLET AVE, CHICAGO, IL 60633-1703
(773) 646-4126
Mailing address
13157 S CARONDOLET AVE, CHICAGO, IL 60633-1703
(773) 646-4126
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06004851A
IN
225200000X
Physical Therapy Assistant
Primary
160.003705
IL
Other
Enumeration date
10/28/2014
Last updated
10/28/2014
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