Provider Demographics
NPI:1902639313
Name:VIVEROS, ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VIVEROS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E ARMY TRAIL RD STE 135
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2140
Mailing Address - Country:US
Mailing Address - Phone:630-894-0606
Mailing Address - Fax:
Practice Address - Street 1:303 E ARMY TRAIL RD STE 135
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2140
Practice Address - Country:US
Practice Address - Phone:630-894-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.028444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist