Provider Demographics
NPI:1114305679
Name:WILLIAMS, ELISE C (PT,DPT)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:C
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1 S GREENLEAF ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3370
Mailing Address - Country:US
Mailing Address - Phone:847-599-9171
Mailing Address - Fax:
Practice Address - Street 1:1 S GREENLEAF ST
Practice Address - Street 2:SUITE I
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3370
Practice Address - Country:US
Practice Address - Phone:847-599-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.020865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist