Provider Demographics
NPI:1891959557
Name:MONTEMURRO, LUISA DOMENICA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:DOMENICA
Last Name:MONTEMURRO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:570-550-0168
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:1020 N WISCONSIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1165
Practice Address - Country:US
Practice Address - Phone:262-725-0237
Practice Address - Fax:262-740-3437
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11062-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00851037OtherRAILROAD MEDICARE NUMBER
WI0604410001OtherDMERC
WI005185940Medicare PIN