Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 05006226A | IN |
N | 225100000X | Physical Therapist | 70011379 | IL |
Y | 2251P0200X | Physical Therapist - Pediatrics | 05006226A | IN |
NPI | 1063630317 |
---|---|
Provider Name | Toni Alexeychuk |
First Address | Mokena, IL 60448-9274 |
Second Address | Mokena, IL 60448-9274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 15/08/2007 |