Provider Demographics
NPI:1568503431
Name:WESOLOWSKI, LISA (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WESOLOWSKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8437
Mailing Address - Country:US
Mailing Address - Phone:630-856-8200
Mailing Address - Fax:630-856-8212
Practice Address - Street 1:619 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-8437
Practice Address - Country:US
Practice Address - Phone:630-856-8200
Practice Address - Fax:630-856-8212
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist