Provider Demographics
NPI:1598262388
Name:CERNETIG, ELIZABETH R (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:CERNETIG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:KOZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3825 N KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6397
Mailing Address - Country:US
Mailing Address - Phone:312-654-3939
Mailing Address - Fax:
Practice Address - Street 1:265 MORTHLAND DR STE A
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6205
Practice Address - Country:US
Practice Address - Phone:219-926-5850
Practice Address - Fax:219-250-2072
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012990A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist