Healthcare Provider Details

I. General information

NPI: 1316997919
Provider Name (Legal Business Name): ELIZABETH YERLY HILSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN YERLY

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 S STATE ST STE 300
CHICAGO IL
60605-2775
US

IV. Provider business mailing address

1103 S STATE ST STE 300
CHICAGO IL
60605-2775
US

V. Phone/Fax

Practice location:
  • Phone: 312-877-5101
  • Fax:
Mailing address:
  • Phone: 312-877-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070014076
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096001999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: