Individual
MRS. ELIZABETH DONALDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10000 S MAIN ST, CHATHAM, IL 62629-7400
(217) 622-1082
Mailing address
10000 S MAIN ST, CHATHAM, IL 62629-7400
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005788
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160005788
STATE OF ILLINOIS PTA LICENSE
IL
Enumeration date
04/30/2019
Last updated
04/30/2019
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