Provider Demographics
NPI:1598942971
Name:ELIZABETH HART, M.P.T. & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ELIZABETH HART, M.P.T. & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:847-425-1800
Mailing Address - Street 1:1618 ORRINGTON AVE STE 322
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5060
Mailing Address - Country:US
Mailing Address - Phone:847-425-1800
Mailing Address - Fax:847-425-1818
Practice Address - Street 1:1618 ORRINGTON AVE STE 322
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5060
Practice Address - Country:US
Practice Address - Phone:847-425-1800
Practice Address - Fax:847-425-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001622839OtherBLUE CROSS BLUE SHIELD
IL0001622839OtherBLUE CROSS BLUE SHIELD