Provider Demographics
NPI:1699560011
Name:LOPEZ-ROSALES, DEISY (LMT)
Entity type:Individual
Prefix:
First Name:DEISY
Middle Name:
Last Name:LOPEZ-ROSALES
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6056 S 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT ARGO
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1523
Mailing Address - Country:US
Mailing Address - Phone:708-299-7159
Mailing Address - Fax:
Practice Address - Street 1:6056 S 74TH AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT ARGO
Practice Address - State:IL
Practice Address - Zip Code:60501-1523
Practice Address - Country:US
Practice Address - Phone:708-299-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227020685225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist