Provider Demographics
NPI:1104955277
Name:PETROPOULOS, ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PETROPOULOS
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6N406 BAKER DR
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-1936
Mailing Address - Country:US
Mailing Address - Phone:847-917-5210
Mailing Address - Fax:847-481-0232
Practice Address - Street 1:6N406 BAKER DR
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-1936
Practice Address - Country:US
Practice Address - Phone:847-917-5210
Practice Address - Fax:847-481-0232
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700035312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0007153719OtherAETNA
1871690446OtherNPI TYPE 2
IL4532188OtherBCBS