Provider Demographics
NPI:1801932496
Name:HUANG, LANAE L (P T)
Entity type:Individual
Prefix:
First Name:LANAE
Middle Name:L
Last Name:HUANG
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 N KNOXVILLE AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2079
Mailing Address - Country:US
Mailing Address - Phone:309-693-9189
Mailing Address - Fax:309-693-9946
Practice Address - Street 1:7725 N KNOXVILLE AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2079
Practice Address - Country:US
Practice Address - Phone:309-693-9189
Practice Address - Fax:309-693-9946
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0037240727OtherIL BCBS PROVIDER NUMBER
ILK40210Medicare PIN