Provider Demographics
NPI:1255689220
Name:IPAPO, MA. LOURDES L (PT)
Entity Type:Individual
Prefix:
First Name:MA. LOURDES
Middle Name:L
Last Name:IPAPO
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 1:5461 N EAST RIVER RD
Mailing Address - Street 2:APT 900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5421 N EAST RIVER RD
Practice Address - Street 2:APT 404
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1129
Practice Address - Country:US
Practice Address - Phone:773-895-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-24
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015513261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy