MEDICARE: DR. ELIZABETH ANNE CHESAREK DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT009890	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033433065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANNE CHESAREK DPT

Provider Business Mailing Address
First Line	:	3113 PIPER DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 N DRUID HILLS RD NE STE A100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3921
Country	:	US
Telephone Number	:	470-427-3840
Fax Number	:	470-200-2818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	11/10/2021

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