Maria Nessan Venerable Lobos
Physical Therapy Assistant in Loves Park, IL. Individual provider (NPI-1).
NPI number1164190849
StatusActive
Last updated in NPPESAug 30, 2021
Details
- NPI
- 1164190849
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Maria Nessan Venerable Lobos
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 30, 2021
- Certification date
- Aug 24, 2021
- Last updated
- Aug 30, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | 1600074013 | IL | Yes |
Practice location
2006 Evans AveLoves Park, IL 61111-3235
Phone 847-630-9010
Mailing address
4141 N Rockton AveRockford, IL 61103-1524
Phone 815-316-1519
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