Provider Demographics
NPI:1003050741
Name:PALUCH, LAURA CHRISTIN (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CHRISTIN
Last Name:PALUCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 DIVISION ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5587
Mailing Address - Country:US
Mailing Address - Phone:224-544-0391
Mailing Address - Fax:
Practice Address - Street 1:164 DIVISION ST
Practice Address - Street 2:SUITE 509
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5587
Practice Address - Country:US
Practice Address - Phone:224-544-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227009241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist