Provider Demographics
NPI:1942273347
Name:DEPASQUALE, LISA VICTORIA
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:VICTORIA
Last Name:DEPASQUALE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:VICTORIA
Other - Last Name:SAPP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT DSC ECS
Mailing Address - Street 1:3430 GRAND AVE
Mailing Address - Street 2:400
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-782-9860
Mailing Address - Fax:
Practice Address - Street 1:3430 GRAND AVE
Practice Address - Street 2:400
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3741
Practice Address - Country:US
Practice Address - Phone:847-782-9860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003849171000000X
IL5264199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171000000XOther Service ProvidersMilitary Health Care Provider