Provider Demographics
NPI:1528074655
Name:LABORAY, KATHLEEN F (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:LABORAY
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 1:315 YAEGER LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-4318
Mailing Address - Country:US
Mailing Address - Phone:217-246-6026
Mailing Address - Fax:
Practice Address - Street 1:20733 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-3710
Practice Address - Country:US
Practice Address - Phone:217-854-3839
Practice Address - Fax:217-854-9820
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-006264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist