Provider Demographics
NPI:1982755260
Name:LUZANO, CRISPINO JR (PT)
Entity Type:Individual
Prefix:
First Name:CRISPINO
Middle Name:
Last Name:LUZANO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 NEWPORT DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3832
Mailing Address - Country:US
Mailing Address - Phone:847-797-1050
Mailing Address - Fax:847-797-1337
Practice Address - Street 1:151 W GOLF RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3213
Practice Address - Country:US
Practice Address - Phone:847-367-9924
Practice Address - Fax:847-367-8093
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist