Provider Demographics
NPI:1508925520
Name:DODD-HENLEY, ELIZABETH M (PT,OCS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:DODD-HENLEY
Suffix:
Gender:F
Credentials:PT,OCS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,OCS
Mailing Address - Street 1:545 PLAINFIELD RD STE E
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7601
Mailing Address - Country:US
Mailing Address - Phone:630-321-2296
Mailing Address - Fax:630-321-2146
Practice Address - Street 1:545 PLAINFIELD RD STE E
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7601
Practice Address - Country:US
Practice Address - Phone:630-321-2296
Practice Address - Fax:630-321-2146
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008189261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001632528OtherBCBS PROVIDER NUMBER
IL7967379OtherAETNA PROVIDER NUMBER
IL7967379OtherAETNA PROVIDER NUMBER