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General NPI Number Information
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NPI Number | 1265836225
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Entity Type | Organization
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Legal Business Name | ELIZABETH HART PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 1609 SHERMAN AVE SUITE 331
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City | EVANSTON
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State | IL
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Zip | 60201-3753
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Country | US
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Telephone | 847-425-1800
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Fax | 847-425-1807
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Provider Business Mailing Address
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Address Line | 1609 SHERMAN AVE SUITE 331
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City | EVANSTON
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State | IL
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Zip | 60201-3753
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Country | US
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Telephone | 847-425-1800
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Fax | 847-425-1807
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TRACEY CELLA
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Credential |
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Telephone | 847-425-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070007986
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License Number State | IL
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