Provider Demographics
NPI:1568031490
Name:ELSA GOULD PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:ELSA GOULD PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:630-235-4707
Mailing Address - Street 1:2526 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2319
Mailing Address - Country:US
Mailing Address - Phone:630-235-4707
Mailing Address - Fax:
Practice Address - Street 1:2609 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1501
Practice Address - Country:US
Practice Address - Phone:847-440-5932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy