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General NPI Number Information
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NPI Number | 1306503180
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Entity Type | Individual
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Provider Name | ELIZABETH JENNIFER CASALETTO PTA
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Gender | Female
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 801 N CASS AVE STE 100
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City | WESTMONT
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State | IL
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Zip | 60559-1173
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Country | US
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Telephone | 630-967-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 23 KENSINGTON CIR APT 108
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City | WHEATON
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State | IL
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Zip | 60189-2945
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Country | US
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Telephone | 630-815-8672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160009468
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License Number State | IL
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