Provider Demographics
NPI:1760671143
Name:MCELROY, BRUCE ALBERT (LPT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALBERT
Last Name:MCELROY
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 SHADOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8386
Mailing Address - Country:US
Mailing Address - Phone:815-893-0377
Mailing Address - Fax:
Practice Address - Street 1:1047 SHADOWOOD LN
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8386
Practice Address - Country:US
Practice Address - Phone:815-893-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic