Provider Demographics
NPI:1669820775
Name:THUROW, NICOLE RENE (PT , DPT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RENE
Last Name:THUROW
Suffix:
Gender:F
Credentials:PT , DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENE
Other - Last Name:GAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT , DPT
Mailing Address - Street 1:246 PEBBLECREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2709
Mailing Address - Country:US
Mailing Address - Phone:815-258-5516
Mailing Address - Fax:
Practice Address - Street 1:1352 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3795
Practice Address - Country:US
Practice Address - Phone:847-549-1460
Practice Address - Fax:847-549-1490
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist