Provider Demographics
NPI:1568515849
Name:HART, ELIZABETH (MPT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 ORRINGTON AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5016
Mailing Address - Country:US
Mailing Address - Phone:847-425-1800
Mailing Address - Fax:847-425-1818
Practice Address - Street 1:1618 ORRINGTON AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5016
Practice Address - Country:US
Practice Address - Phone:847-425-1800
Practice Address - Fax:847-425-1818
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001622839OtherBLUE CROSS BLUE SHIELD
IL212912Medicare ID - Type Unspecified