Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 096001304 | IL |
NPI | 1912358847 |
---|---|
Provider Name | Kevin Laudner |
First Address | Normal, IL 61709-5000 |
Second Address | Normal, IL 61709-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 22/06/2016 |