Provider Demographics
NPI:1063859833
Name:RODGERS, ELIZABETH A (PT,DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:MIZERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:17129 S HARLEM AVE, STE B3
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477
Practice Address - Country:US
Practice Address - Phone:630-967-2000
Practice Address - Fax:708-745-5115
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist