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NPI Code Detail

MEDICARE: LISA A ELIAS PT

MEDICARE: LISA A ELIAS PT
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
1225100000XPhysical Therapist070013155IL

General Provider Information

NPI Number : 1053368506
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA A ELIAS PT
Provider Business Mailing Address
First Line : 2000 LAKE AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-7401
Country : US
Telephone Number : 815-337-7100
Fax Number :
Provider Business Practice Location Address
First Line : 2000 LAKE AVE
Second Line :
City : WOODSTOCK
State : IL
Zip : 60098-7401
Country : US
Telephone Number : 815-337-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 09/17/2009

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Directions to “ LISA A ELIAS PT” Practice Location

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