Provider Demographics
NPI:1932373859
Name:DEL ROSARIO, LADONNA I (PT)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:I
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:233 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1666
Practice Address - Country:US
Practice Address - Phone:847-735-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBCBS OF ILOther1619980
ILR03221Medicare PIN
IL568080Medicare PIN
IL567700Medicare PIN
ILR03222Medicare PIN
ILBCBS OF ILOther1619980
IL568150Medicare PIN