Provider Demographics
NPI:1164022398
Name:GRUSY, ALESHKA (PTA)
Entity Type:Individual
Prefix:
First Name:ALESHKA
Middle Name:
Last Name:GRUSY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111A W KAUFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:CONGERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61729-9565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6901 N GALENA RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-3193
Practice Address - Country:US
Practice Address - Phone:309-692-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008266225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant