Provider Demographics
NPI:1447349527
Name:SCROGGINS, LAURA LYNN (LPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:1403 W FERDON ST
Mailing Address - Street 2:STE 20
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-4448
Mailing Address - Country:US
Mailing Address - Phone:217-324-6997
Mailing Address - Fax:217-324-6992
Practice Address - Street 1:1403 W FERDON ST
Practice Address - Street 2:STE 20
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-4448
Practice Address - Country:US
Practice Address - Phone:217-324-6997
Practice Address - Fax:217-324-6992
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
371404054OtherGROUP HEALTH PLAN
371404054OtherPHCS
IL448117OtherHEALTHLINK
IL133693100OtherOFFICE OF WORKERS COMPENS
7499545OtherAETNA
2281494OtherFIRST HEALTH
IL05927690OtherBLUE CROSS BLUE SHIELD
371404054001OtherTRICARE FOR LIFE
371404054OtherGROUP HEALTH PLAN
IL5092360001Medicare NSC
ILP00262102Medicare ID - Type UnspecifiedRAILROAD MEDICARE
371404054001OtherTRICARE FOR LIFE