Provider Demographics
NPI:1639503808
Name:LISKA, STEVEN (PT, DPT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:LISKA
Suffix:
Gender:M
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 W ROSCOE ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7209
Mailing Address - Country:US
Mailing Address - Phone:847-476-2945
Mailing Address - Fax:
Practice Address - Street 1:1352 PATRIOT BLVD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-7777
Practice Address - Country:US
Practice Address - Phone:847-581-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist