Healthcare Provider Details

I. General information

NPI: 1063180362
Provider Name (Legal Business Name): LAURA ELIZABETH LUPO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA E MURPHY DPT

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 W 95TH ST
OAK LAWN IL
60453-2611
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-967-2000
  • Fax: 630-348-3942
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-026221
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: