Healthcare Provider Details

I. General information

NPI: 1962678052
Provider Name (Legal Business Name): LANCE LABNO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LINDEN AVE
WILMETTE IL
60091-2843
US

IV. Provider business mailing address

2441 PROSPECT AVE
EVANSTON IL
60201-1839
US

V. Phone/Fax

Practice location:
  • Phone: 847-372-3816
  • Fax:
Mailing address:
  • Phone: 847-372-3816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number070015607
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number070015607
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number070015607
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070015607
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227001920
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: