Provider Demographics
NPI:1144823972
Name:LAVENDER PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:LAVENDER PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:224-616-1627
Mailing Address - Street 1:775 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:775 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-5569
Practice Address - Country:US
Practice Address - Phone:224-616-1627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health