Provider Demographics
NPI:1689926131
Name:GAUTHIER, LAURIE DYAN (DPT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:DYAN
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:DYAN
Other - Last Name:KRAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:312-694-7337
Mailing Address - Fax:312-694-9116
Practice Address - Street 1:1000 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:312-694-7337
Practice Address - Fax:312-694-9116
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist