Healthcare Provider Details

I. General information

NPI: 1669578258
Provider Name (Legal Business Name): ELAINE GOTTLINGER P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE WHITCRAFT P.T.A.

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 170TH ST
HAZEL CREST IL
60429-1451
US

IV. Provider business mailing address

1816 170TH ST
HAZEL CREST IL
60429-1451
US

V. Phone/Fax

Practice location:
  • Phone: 708-335-1415
  • Fax:
Mailing address:
  • Phone: 708-335-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160-001983
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: