Provider Demographics
NPI:1447349527
Name:SCROGGINS, LAURA LYNN (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:721 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62014-1503
Mailing Address - Country:US
Mailing Address - Phone:618-585-3522
Mailing Address - Fax:618-585-3523
Practice Address - Street 1:721 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:IL
Practice Address - Zip Code:62014-1503
Practice Address - Country:US
Practice Address - Phone:618-585-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05927690OtherBLUE CROSS BLUE SHIELD
371404054001OtherTRICARE FOR LIFE
2281494OtherFIRST HEALTH
7499545OtherAETNA
371404054OtherGROUP HEALTH PLAN
371404054OtherPHCS
IL133693100OtherOFFICE OF WORKERS COMPENS
IL448117OtherHEALTHLINK
371404054OtherGROUP HEALTH PLAN
IL5092360001Medicare NSC
ILP00262102Medicare ID - Type UnspecifiedRAILROAD MEDICARE
371404054001OtherTRICARE FOR LIFE