Provider Demographics
NPI:1073881801
Name:JAVORKUTI, LISA CHRISTINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:CHRISTINE
Last Name:JAVORKUTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 S CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2903
Mailing Address - Country:US
Mailing Address - Phone:847-837-0623
Mailing Address - Fax:
Practice Address - Street 1:63 S CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2903
Practice Address - Country:US
Practice Address - Phone:847-837-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.003202225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist