Provider Demographics
NPI:1407622590
Name:REXFORD, ELIZABETH ANNE JACKLYN (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE JACKLYN
Last Name:REXFORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 UNITED DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-7428
Mailing Address - Country:US
Mailing Address - Phone:618-343-1122
Mailing Address - Fax:618-343-1444
Practice Address - Street 1:101 UNITED DR STE 100
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-7428
Practice Address - Country:US
Practice Address - Phone:618-407-4026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist