Provider Demographics
NPI:1821390253
Name:HACKL, LAURA A (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:HACKL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1544
Mailing Address - Country:US
Mailing Address - Phone:847-256-4230
Mailing Address - Fax:
Practice Address - Street 1:984 WILLOW RD
Practice Address - Street 2:SUITE F
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6821
Practice Address - Country:US
Practice Address - Phone:847-562-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist