Provider Demographics
NPI:1417224320
Name:LOSOLE, ELIZABETH MARIA (PTA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:LOSOLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3100
Mailing Address - Country:US
Mailing Address - Phone:847-352-5500
Mailing Address - Fax:847-352-8592
Practice Address - Street 1:675 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3100
Practice Address - Country:US
Practice Address - Phone:847-352-5500
Practice Address - Fax:847-352-8592
Is Sole Proprietor?:No
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.003195174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist