Provider Demographics
NPI:1588905731
Name:BROWN, ELISE MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:ELISE
Other - Middle Name:MARIE
Other - Last Name:LIVENGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 PAHL RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3329
Mailing Address - Country:US
Mailing Address - Phone:805-674-8565
Mailing Address - Fax:
Practice Address - Street 1:816 PAHL RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3329
Practice Address - Country:US
Practice Address - Phone:805-674-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019120225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics