Provider Demographics
NPI:1528361961
Name:LAZY DOG THERAPEUTICS P.C.
Entity Type:Organization
Organization Name:LAZY DOG THERAPEUTICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BIXBY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-703-3394
Mailing Address - Street 1:5428 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7318
Mailing Address - Country:US
Mailing Address - Phone:815-703-3384
Mailing Address - Fax:
Practice Address - Street 1:5428 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7318
Practice Address - Country:US
Practice Address - Phone:815-703-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty