Provider Demographics
NPI:1992752901
Name:ELICIER, ILEANA ANTONIA (PT)
Entity type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:ANTONIA
Last Name:ELICIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3637
Mailing Address - Country:US
Mailing Address - Phone:847-215-8284
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE. & ROOSEVELT RD.
Practice Address - Street 2:HINES VA (117-G)
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-2281
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 3167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist