Provider Demographics
NPI:1619219201
Name:LAURENCE, WHITNEY (DPT)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:
Last Name:LAURENCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3704
Mailing Address - Country:US
Mailing Address - Phone:847-570-7170
Mailing Address - Fax:847-570-7172
Practice Address - Street 1:1729 BENSON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3704
Practice Address - Country:US
Practice Address - Phone:847-570-7170
Practice Address - Fax:847-570-7172
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist