Provider Demographics
NPI:1861576894
Name:WANG, ELIZABETH JANKAUSKIS (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANKAUSKIS
Last Name:WANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ALLISON
Other - Last Name:JANKAUSKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18 N CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5930
Mailing Address - Country:US
Mailing Address - Phone:708-482-9453
Mailing Address - Fax:708-482-9454
Practice Address - Street 1:18 N CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5930
Practice Address - Country:US
Practice Address - Phone:708-482-9453
Practice Address - Fax:708-482-9454
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist