Provider Demographics
NPI:1649747270
Name:POLLASTRINI, ALYSSA M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:POLLASTRINI
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 1:530 ROCKLAND RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4137
Mailing Address - Country:US
Mailing Address - Phone:815-893-8480
Mailing Address - Fax:815-893-8481
Practice Address - Street 1:530 ROCKLAND RD STE 500
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4137
Practice Address - Country:US
Practice Address - Phone:815-893-8480
Practice Address - Fax:815-893-8481
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0240632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1558895797OtherPHYSICAL THERAPY
IL1326404682OtherPHYSICAL THERAPY