Individual
ELIAS BOUSHEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5255 E MARYLAND ST, DECATUR, IL 62521-9705
(217) 864-1264
(217) 864-1828
Mailing address
1311 MAMARONECK AVE STE 140, WHITE PLAINS, NY 10605-5224
(914) 294-4050
(631) 760-8306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070027717
IL
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
11/29/2018
Last updated
09/15/2023
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