Provider Demographics
NPI:1548509516
Name:LAURELES, SHEREE ANN (PT)
Entity type:Individual
Prefix:
First Name:SHEREE ANN
Middle Name:
Last Name:LAURELES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4056 W 115TH ST APT 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-4334
Mailing Address - Country:US
Mailing Address - Phone:773-991-6661
Mailing Address - Fax:
Practice Address - Street 1:8001 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5930
Practice Address - Country:US
Practice Address - Phone:773-436-6600
Practice Address - Fax:773-434-6246
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist