Provider Demographics
NPI:1174808851
Name:GRUBER, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RAND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:
Practice Address - Street 1:1025 RED OAK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-5017
Practice Address - Country:US
Practice Address - Phone:847-245-7175
Practice Address - Fax:847-245-7476
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI859400072OtherMEDICARE
WIP01061665OtherRAILROAD MEDICARE