Provider Demographics
NPI:1902631476
Name:SHKUKANI, ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:SHKUKANI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 WARWICK LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4602
Mailing Address - Country:US
Mailing Address - Phone:708-971-4714
Mailing Address - Fax:
Practice Address - Street 1:10820 WARWICK LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4602
Practice Address - Country:US
Practice Address - Phone:708-971-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.028500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist