Provider Demographics
NPI:1639461809
Name:ALVAREZ, ALFREDO (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 MONTAUK LN
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9164
Mailing Address - Country:US
Mailing Address - Phone:847-946-0724
Mailing Address - Fax:
Practice Address - Street 1:469 MONTAUK LN
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-9164
Practice Address - Country:US
Practice Address - Phone:847-946-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.010131225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist