Healthcare Provider Details

I. General information

NPI: 1679558308
Provider Name (Legal Business Name): ELA DARGIEL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E PALATINE RD
PALATINE IL
60074-5551
US

IV. Provider business mailing address

909 E PALATINE RD
PALATINE IL
60074-5551
US

V. Phone/Fax

Practice location:
  • Phone: 847-776-1400
  • Fax: 847-776-1424
Mailing address:
  • Phone: 847-776-1400
  • Fax: 847-776-1424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070007524
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: