Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 22594 | MA |
Y | 2251N0400X | Physical Therapist - Neurology | 070023361 | IL |
NPI | 1326598822 |
---|---|
Provider Name | Alyssa Andreasik |
First Address | Buffalo Grove, IL 60089-3276 |
Second Address | Chicago, IL 60611-3167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2016 |
Last Update Date | 20/10/2017 |