Basic Information
| Provider Information | |||||||||
| NPI: | 1154526291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIG | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | |||||||||
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| OtherOrganizationType: | |||||||||
| OtherLastName: | CUFFEY | ||||||||
| OtherFirstName: | LORI | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 202 FALCON CREST DR | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618589573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2176491459 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 620 WARRINGTON AVENUE | ||||||||
| Address2: | COLONIAL MANOR | ||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618326183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174460660 | ||||||||
| FaxNumber: | 8474410734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070.008263 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 070-008263 | 01 | IL | STATE LICENSE | OTHER |