Healthcare Provider Details

I. General information

NPI: 1508924101
Provider Name (Legal Business Name): ELIZABETH FITZGERALD O'RIORDAN P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

5426 W ARDMORE AVE
CHICAGO IL
60646-6504
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-2709
  • Fax:
Mailing address:
  • Phone: 312-493-2902
  • Fax: 312-873-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070011697
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: