Elizabeth Donaldson, PTA
Individual provider Active NPI Physical Therapy Assistant · Chatham, IL
NPI 1972167328 · NPPES record last updated Apr 30, 2019
Key facts
- NPI
- 1972167328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160005788 (IL)
- Practice address
- 10000 S Main St
Chatham, IL 62629-7400 - Phone
- (217) 622-1082
- NPI assigned
- Apr 30, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 160005788 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160005788 | IL | Yes |
Addresses
Primary practice location
10000 S Main St
Chatham, IL 62629-7400
Mailing address
10000 S Main St
Chatham, IL 62629-7400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160005788 | Other | IL | STATE OF ILLINOIS PTA LICENSE |
Other providers in Chatham, IL
- Alysha P Davis-Barth
- Emilee Davison
- Tara M. Dillon
- Colleen Mary Dinges
- Kristina Doan
- Ellyn Joyce Driver
- Stephen Randall Dwyer
- Dynamic Behavioral Services, Inc.
- Eat to Grow, Inc.
- Family Medical Center of Chatham, LLC
All providers in Chatham, IL · Physical Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2019. 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.