Provider Demographics
NPI:1083795645
Name:CABAGE, LAURA KAY (MPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:CABAGE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2911
Mailing Address - Country:US
Mailing Address - Phone:630-204-6279
Mailing Address - Fax:630-522-4765
Practice Address - Street 1:115 N GENEVA AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2911
Practice Address - Country:US
Practice Address - Phone:630-204-6279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-011891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist