Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 181.000406 | IL |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 181.000406 | IL |
N | 225700000X | Massage Therapist |
NPI | 1568033629 |
---|---|
Provider Name | Dr. Gladys Lara |
First Address | Chicago, IL 60641-4617 |
Second Address | Chicago, IL 60641-4617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 06/10/2021 |