Provider Demographics
NPI:1457668824
Name:LINGATONG, VANESSA ESPURA (RPT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ESPURA
Last Name:LINGATONG
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 N CUMBERLAND AVE
Mailing Address - Street 2:101A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1490
Mailing Address - Country:US
Mailing Address - Phone:773-444-0400
Mailing Address - Fax:
Practice Address - Street 1:5440 N CUMBERLAND AVE
Practice Address - Street 2:101A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1490
Practice Address - Country:US
Practice Address - Phone:773-444-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist