Provider Demographics
NPI:1942484233
Name:BISCHOFF, ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:BISCHOFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:605 E SOUTHLINE RD
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-2053
Practice Address - Country:US
Practice Address - Phone:217-253-9100
Practice Address - Fax:217-253-9103
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4117OtherHEALTH ALLIANCE
IL113326OtherHEALTHLINK
IL203OtherBLUE CROSS
IL7216OtherPERSONALCARE
IL203OtherBLUE CROSS
IL$$$$$$$$$001Medicaid