Provider Demographics
NPI:1578287041
Name:BEIRNE, ALYSIA SARA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ALYSIA
Middle Name:SARA
Last Name:BEIRNE
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 1:2500 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1223
Mailing Address - Country:US
Mailing Address - Phone:708-616-5055
Mailing Address - Fax:
Practice Address - Street 1:2615 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-2450
Practice Address - Country:US
Practice Address - Phone:708-493-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070026901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist