Provider Demographics
NPI:1083193718
Name:TOUSSAINT, ALICIA ROSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ROSE
Last Name:TOUSSAINT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11334 S HOMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-3508
Mailing Address - Country:US
Mailing Address - Phone:773-910-7485
Mailing Address - Fax:
Practice Address - Street 1:11334 S HOMAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3508
Practice Address - Country:US
Practice Address - Phone:773-910-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.020837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist