Provider Demographics
NPI:1316997919
Name:HILSEN, ELIZABETH YERLY (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:YERLY
Last Name:HILSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:YERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1103 S STATE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2775
Mailing Address - Country:US
Mailing Address - Phone:312-877-5101
Mailing Address - Fax:
Practice Address - Street 1:1103 S STATE ST STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2775
Practice Address - Country:US
Practice Address - Phone:312-877-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014076225100000X
IL0960019992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILUS DEPT OF LABOROther367885100
ILUS DEPT OF LABOROther367885100
IL202542Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILR03816Medicare PIN
IL568080Medicare PIN
ILR03815Medicare PIN
IL1623066OtherBCBS PROVIDER
IL1619908OtherBCBS IL GROUP NUMBER
IL567700Medicare PIN
ILK14208Medicare PIN
ILK14207Medicare PIN
ILK14202Medicare PIN
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL568150Medicare PIN