Healthcare Provider Details

I. General information

NPI: 1801932496
Provider Name (Legal Business Name): LANAE L HUANG P. T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 N KNOXVILLE AVE LOWER LEVEL
PEORIA IL
61614-2079
US

IV. Provider business mailing address

7725 N KNOXVILLE AVE LOWER LEVEL
PEORIA IL
61614-2079
US

V. Phone/Fax

Practice location:
  • Phone: 309-693-9189
  • Fax: 309-693-9946
Mailing address:
  • Phone: 309-693-9189
  • Fax: 309-693-9946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070012578
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: