Healthcare Provider Details

I. General information

NPI: 1518241066
Provider Name (Legal Business Name): ELIZABETH ANNE KOTARINOS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRANSAM PLAZA DR STE 170
OAKBROOK TERRACE IL
60181-4822
US

IV. Provider business mailing address

1 TRANSAM PLAZA DR STE 170
OAKBROOK TERRACE IL
60181-4822
US

V. Phone/Fax

Practice location:
  • Phone: 630-620-0232
  • Fax: 630-620-0322
Mailing address:
  • Phone: 630-620-0232
  • Fax: 630-620-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.017364
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: