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NPI Code Detail

MEDICARE: ELIZABETH BOURLAS DPT

MEDICARE:   ELIZABETH  BOURLAS  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
1225100000XPhysical Therapist070019580IL

General Provider Information

NPI Number : 1629312533
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BOURLAS DPT
Provider Business Mailing Address
First Line : 625 ENTERPRISE DR
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8813
Country : US
Telephone Number : 630-575-6250
Fax Number : 630-575-7450
Provider Business Practice Location Address
First Line : 24 S MORGAN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-3668
Country : US
Telephone Number : 312-421-7274
Fax Number : 312-421-7289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2012
Last Update Date : 03/14/2017

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Directions to “ ELIZABETH BOURLAS DPT” Practice Location

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