Healthcare Provider Details

I. General information

NPI: 1831935832
Provider Name (Legal Business Name): LAURIANNE SANTOS LLAMANZARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N MARKET ST
KNOXVILLE IL
61448-1096
US

IV. Provider business mailing address

383 E FERRIS ST APT 33
GALESBURG IL
61401-4856
US

V. Phone/Fax

Practice location:
  • Phone: 309-289-2338
  • Fax:
Mailing address:
  • Phone: 917-361-9905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070026832
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: