Provider Demographics
NPI:1407033343
Name:BOERSMA, ELIZABETH (MS PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BOERSMA
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:26555 S JACOB DR
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5493
Mailing Address - Country:US
Mailing Address - Phone:815-483-8944
Mailing Address - Fax:815-521-2896
Practice Address - Street 1:26555 S JACOB DR
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5493
Practice Address - Country:US
Practice Address - Phone:815-483-8944
Practice Address - Fax:815-521-2896
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist