Provider Demographics
NPI:1932254406
Name:ELLIOTT-BURKE, TERESA LYNN (PT, MHS)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:ELLIOTT-BURKE
Suffix:
Gender:F
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1396
Mailing Address - Country:US
Mailing Address - Phone:847-438-6016
Mailing Address - Fax:847-550-9780
Practice Address - Street 1:755 ELA RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2337
Practice Address - Country:US
Practice Address - Phone:847-550-9784
Practice Address - Fax:847-550-9780
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04925901OtherBCBS OF IL PROVIDER
IL04925901OtherBCBS OF IL PROVIDER
IL208478Medicare PIN