Provider Demographics
NPI:1306369715
Name:LIUTKUS, JESSICA SOFIE (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SOFIE
Last Name:LIUTKUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16543 S CATAWBA RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9633
Mailing Address - Country:US
Mailing Address - Phone:773-865-6343
Mailing Address - Fax:
Practice Address - Street 1:13010 PASEO LUCIDO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4478
Practice Address - Country:US
Practice Address - Phone:858-485-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer