Provider Demographics
NPI:1417246638
Name:LOSCH, NIKOLE (DPT)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:LOSCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W DEPOT ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1500
Mailing Address - Country:US
Mailing Address - Phone:847-838-8085
Mailing Address - Fax:
Practice Address - Street 1:311 W DEPOT ST
Practice Address - Street 2:SUITE N
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1500
Practice Address - Country:US
Practice Address - Phone:847-838-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist