Healthcare Provider Details

I. General information

NPI: 1861304925
Provider Name (Legal Business Name): ELIZABETH GREGORY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 N ILLINOIS ST STE 101
FAIRVIEW HEIGHTS IL
62208-3500
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-9300
  • Fax: 618-624-9330
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070040015
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: