Provider Demographics
NPI:1447471180
Name:GABREK, ELAINE LOUISE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:LOUISE
Last Name:GABREK
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 1:415 S EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6122
Mailing Address - Country:US
Mailing Address - Phone:708-354-3872
Mailing Address - Fax:
Practice Address - Street 1:818 OAK CREEK DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6405
Practice Address - Country:US
Practice Address - Phone:630-268-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
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
IL549780Medicare ID - Type Unspecified