1902874720 NPI number — ALYSSA EMANUELSON ATC, LGI

Table of content: ALYSSA EMANUELSON ATC, LGI (NPI 1902874720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902874720 NPI number — ALYSSA EMANUELSON ATC, LGI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMANUELSON
Provider First Name:
ALYSSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC, LGI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902874720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
849 PIKE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTTAWA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61350-4780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-252-3471
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ATI PHYSICAL THERAPY
Provider Second Line Business Practice Location Address:
3082 CATON FARM RD
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-577-9936
Provider Business Practice Location Address Fax Number:
815-577-9938
Provider Enumeration Date:
03/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)