Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | IL |
NPI | 1104955277 |
---|---|
Provider Name | Elizabeth Petropoulos |
First Address | Elgin, IL 60123-4940 |
Second Address | Elgin, IL 60123-4940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007153719 | AETNA (01) | IL |
4532188 | BCBS (01) | IL |