Beverly Ehlebracht
Individual provider Active NPI Physical Therapy Assistant · Woodrige, IL
NPI 1003278946 · NPPES record last updated Mar 21, 2016
Key facts
- NPI
- 1003278946
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160.006158 (IL)
- Practice address
- 7409 Woodrige Dr
Suite F
Woodrige, IL 60517 - Phone
- (630) 967-2000
- NPI assigned
- Mar 21, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.006158 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.006158 | IL | Yes |
Addresses
Primary practice location
7409 Woodrige Dr
Suite F
Woodrige, IL 60517
Mailing address
1860 Payshere Cir
Chicago, IL 60674-0001
Phone (630) 967-2000
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.