Provider Demographics
NPI:1528217700
Name:SUCHY, ELISA L (PT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:L
Last Name:SUCHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:L
Other - Last Name:FASANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:990 ELK GROVE TOWN CTR
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-290-1111
Practice Address - Fax:847-290-1065
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619980OtherBCBS OF IL
IL1619980OtherBCBS OF IL
ILR03834Medicare PIN
ILR03833Medicare PIN
IL568150Medicare PIN
ILR03835Medicare PIN
IL567700Medicare PIN