Provider Demographics
NPI:1861680290
Name:HILDEBRANDT, LAURA BETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BETH
Last Name:HILDEBRANDT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:GARTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:471 W TERRA COTTA AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3434
Mailing Address - Country:US
Mailing Address - Phone:815-455-0550
Mailing Address - Fax:
Practice Address - Street 1:471 W TERRA COTTA AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3434
Practice Address - Country:US
Practice Address - Phone:815-455-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant