Provider Demographics
NPI:1164431821
Name:THOPE, LALAINE (PT)
Entity Type:Individual
Prefix:MS
First Name:LALAINE
Middle Name:
Last Name:THOPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LALAINE
Other - Middle Name:
Other - Last Name:UY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-366-1323
Mailing Address - Fax:
Practice Address - Street 1:2110 FOX DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7553
Practice Address - Country:US
Practice Address - Phone:217-366-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205364OtherMEDICARE GROUP
ILP00328921OtherRAILROAD MEDICARE
ILP00328921OtherRAILROAD MEDICARE
IL0407950001Medicare NSC
ILP00328921OtherRAILROAD MEDICARE