Healthcare Provider Details

I. General information

NPI: 1154526291
Provider Name (Legal Business Name): LORI L CRAIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI L CUFFEY

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WARRINGTON AVENUE COLONIAL MANOR
DANVILLE IL
61832-6183
US

IV. Provider business mailing address

202 FALCON CREST DR
OAKWOOD IL
61858-9573
US

V. Phone/Fax

Practice location:
  • Phone: 217-446-0660
  • Fax: 847-441-0734
Mailing address:
  • Phone: 217-649-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.008263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: