Provider Demographics
NPI:1871690446
Name:ON SMALL FEET, PC
Entity Type:Organization
Organization Name:ON SMALL FEET, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-917-5210
Mailing Address - Street 1:PO BOX 5810
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60121-5810
Mailing Address - Country:US
Mailing Address - Phone:847-917-5210
Mailing Address - Fax:847-931-1063
Practice Address - Street 1:163 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4940
Practice Address - Country:US
Practice Address - Phone:847-917-5210
Practice Address - Fax:847-931-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004532188OtherBLUE CROSS BLUE SHIELD
IL0007153719OtherAETNA