Provider Demographics
NPI:1386440360
Name:LAUKERT, JAKE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:LAUKERT
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COVENTRY LN STE 170
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7592
Mailing Address - Country:US
Mailing Address - Phone:815-356-2700
Mailing Address - Fax:
Practice Address - Street 1:500 COVENTRY LN STE 170
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7592
Practice Address - Country:US
Practice Address - Phone:815-356-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist