Provider Demographics
NPI:1083960959
Name:KURTH, ELENA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIE
Last Name:KURTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 N LEAVITT ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4822
Mailing Address - Country:US
Mailing Address - Phone:773-248-9578
Mailing Address - Fax:
Practice Address - Street 1:3636 N LEAVITT ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4822
Practice Address - Country:US
Practice Address - Phone:773-248-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-002504174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist