Healthcare Provider Details

I. General information

NPI: 1508685314
Provider Name (Legal Business Name): ELTON MOY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BUSCH PKWY STE 115A
BUFFALO GROVE IL
60089-4541
US

IV. Provider business mailing address

900 RAND RD STE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 224-676-7960
  • Fax: 224-676-7994
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-028552
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: