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General NPI Number Information
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NPI Number | 1467915124
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Entity Type | Individual
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Provider Name | LAUREN NICOLE CHARLES DPT, PT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 110 W WOODSTOCK ST
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-4239
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Country | US
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Telephone | 815-893-9075
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Fax |
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Provider Business Mailing Address
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Address Line | 817 ROSS LN
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City | MCHENRY
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State | IL
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Zip | 60050-2469
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Country | US
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Telephone | 815-363-8124
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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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 | 070.026638
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License Number State | IL
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