Provider Demographics
NPI:1588772271
Name:LOPICCOLO, JAMES ANTHONY (DPT,OCS, ATC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTHONY
Last Name:LOPICCOLO
Suffix:
Gender:M
Credentials:DPT,OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19742 DURHAM CT
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-0300
Mailing Address - Country:US
Mailing Address - Phone:708-261-8830
Mailing Address - Fax:
Practice Address - Street 1:2 RIVER PL STE B
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-6038
Practice Address - Country:US
Practice Address - Phone:708-895-9860
Practice Address - Fax:708-895-9866
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist