Provider Demographics
NPI:1174731418
Name:FLORINE, ELIZABETH VICTORIA (LMT, NCTMB)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VICTORIA
Last Name:FLORINE
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 LAKE PLUMLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5023
Mailing Address - Country:US
Mailing Address - Phone:847-989-0061
Mailing Address - Fax:
Practice Address - Street 1:148 S NORTHWEST HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6325
Practice Address - Country:US
Practice Address - Phone:847-989-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227000321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist