Provider Demographics
NPI:1801833942
Name:TONIDO, ELIZABETH C (LPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:TONIDO
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E IRVING PARK RD
Mailing Address - Street 2:STE. #107
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2048
Mailing Address - Country:US
Mailing Address - Phone:630-439-0009
Mailing Address - Fax:630-439-0011
Practice Address - Street 1:1850 W WINCHESTER RD
Practice Address - Street 2:STE. #220
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5355
Practice Address - Country:US
Practice Address - Phone:847-362-9050
Practice Address - Fax:847-362-9486
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208325003Medicare PIN
ILK35434Medicare PIN
ILK28211Medicare PIN