Provider Demographics
NPI:1891046249
Name:CONSOLACION, ANNA ELAINE (RPT)
Entity Type:Individual
Prefix:MS
First Name:ANNA ELAINE
Middle Name:
Last Name:CONSOLACION
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1519
Mailing Address - Country:US
Mailing Address - Phone:407-967-8065
Mailing Address - Fax:
Practice Address - Street 1:101 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4901
Practice Address - Country:US
Practice Address - Phone:779-423-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist