Provider Demographics
NPI:1033272760
Name:ALONSO, MARISA (PT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:ALONSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 FOUNDERS XING
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6705
Mailing Address - Country:US
Mailing Address - Phone:708-301-3102
Mailing Address - Fax:708-301-3702
Practice Address - Street 1:14815 FOUNDERS XING
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6705
Practice Address - Country:US
Practice Address - Phone:708-301-3102
Practice Address - Fax:708-301-3702
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870484225100000X
IL070.0161622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist