Provider Demographics
NPI:1306800321
Name:JOHNSON, LAUREN K (PT, DPT, PCS)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1846
Mailing Address - Country:US
Mailing Address - Phone:314-704-4315
Mailing Address - Fax:708-680-0126
Practice Address - Street 1:1010 N HOOKER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4549
Practice Address - Country:US
Practice Address - Phone:312-943-3600
Practice Address - Fax:312-943-3096
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0206302251P0200X
IL0700206302251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0403OtherPHYSICAL THERAPY LICENSE