MEDICARE: ELISA M HAYHURST PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070014301	IL

General Provider Information

NPI Number	:	1942232343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA M HAYHURST PT

Provider Business Mailing Address
First Line	:	1860 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0018
Country	:	US
Telephone Number	:	630-469-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-4464
Country	:	US
Telephone Number	:	630-469-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	06/17/2022

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