Provider Demographics
NPI:1447613880
Name:LUKOSE, ROSELIN TOJEN
Entity Type:Individual
Prefix:
First Name:ROSELIN
Middle Name:TOJEN
Last Name:LUKOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 W 113TH ST
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-2022
Mailing Address - Country:US
Mailing Address - Phone:708-745-1520
Mailing Address - Fax:
Practice Address - Street 1:6919 W 113TH ST
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-2022
Practice Address - Country:US
Practice Address - Phone:708-745-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007106225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant