Provider Demographics
NPI:1518328814
Name:LAO, QUIRINO
Entity Type:Individual
Prefix:MR
First Name:QUIRINO
Middle Name:
Last Name:LAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 GROSVENOR LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4411
Mailing Address - Country:US
Mailing Address - Phone:312-320-0576
Mailing Address - Fax:708-798-0801
Practice Address - Street 1:2930 MANNHEIM RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2265
Practice Address - Country:US
Practice Address - Phone:708-798-0800
Practice Address - Fax:708-798-0801
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist