Individual
LAURA FRAIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1040 DIXIE HWY, CHICAGO HEIGHTS, IL 60411-2623
(708) 300-6961
(708) 515-9723
Mailing address
20159 S FAIRWOOD CT, FRANKFORT, IL 60423-6992
(708) 257-5033
(708) 515-9723
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
—
—
251E00000X
Home Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
310400000X
Assisted Living Facility
Primary
—
—
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160000354
PTA LICENSURE
IL
Enumeration date
11/13/2013
Last updated
11/13/2013
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