Provider Demographics
NPI:1871650036
Name:DESORT, LAURA BETH (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:DESORT
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 1:21645 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9366
Mailing Address - Country:US
Mailing Address - Phone:847-535-6557
Mailing Address - Fax:847-535-7834
Practice Address - Street 1:660 N WESTMORELAND RD
Practice Address - Street 2:REHAB SERVICES DEPT
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1659
Practice Address - Country:US
Practice Address - Phone:847-535-6557
Practice Address - Fax:847-535-7834
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-005011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist