Healthcare Provider Details

I. General information

NPI: 1518328814
Provider Name (Legal Business Name): MR. QUIRINO LAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 MANNHEIM RD SUITE 1B
FRANKLIN PARK IL
60131-2265
US

IV. Provider business mailing address

575 GROSVENOR LN
AURORA IL
60504-4411
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-0800
  • Fax: 708-798-0801
Mailing address:
  • Phone: 312-320-0576
  • Fax: 708-798-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070007484
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: