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General NPI Number Information
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NPI Number | 1184143729
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Entity Type | Individual
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Provider Name | LAURA ELIZABETH VINCI DE VANEGAS PT
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Gender | Female
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 355 E ERIE ST
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City | CHICAGO
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State | IL
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Zip | 60611-3167
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Country | US
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Telephone | 312-238-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 240 STRATFORD ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-2143
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Country | US
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Telephone | 617-699-7278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070022954
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 25492
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License Number State | MA
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