Provider Demographics
NPI:1164915997
Name:BESARIO, LOVELY DAWN LUSTRE (PT)
Entity Type:Individual
Prefix:
First Name:LOVELY DAWN
Middle Name:LUSTRE
Last Name:BESARIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 WOODVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-5305
Mailing Address - Country:US
Mailing Address - Phone:224-656-5549
Mailing Address - Fax:
Practice Address - Street 1:2222 14TH ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-7708
Practice Address - Country:US
Practice Address - Phone:847-249-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist