Provider Demographics
NPI:1750561049
Name:THORN, ELIZABETH K (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:THORN
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:9634 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3391
Practice Address - Country:US
Practice Address - Phone:708-423-4800
Practice Address - Fax:708-423-4843
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCJ4383OtherR.R. MEDICARE GROUP #
IL202542OtherMEDICARE GROUP #
IL367885100OtherU S DEPT OF LABOR
IL1623066OtherBCBS PROVIDER #
IL1619908OtherBCBS IL GROUP NUMBER
IL200852OtherMEDICARE GROUP #
IL202542OtherMEDICARE GROUP #
IL568080Medicare PIN
IL367885100OtherU S DEPT OF LABOR
IL1623066OtherBCBS PROVIDER #
ILCJ4383OtherR.R. MEDICARE GROUP #
IL568150Medicare PIN