Provider Demographics
NPI:1679960934
Name:BARON, ALLYSON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:BARON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:FABRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5454 FARGO AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3210
Mailing Address - Country:US
Mailing Address - Phone:847-834-4923
Mailing Address - Fax:
Practice Address - Street 1:5454 FARGO AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3210
Practice Address - Country:US
Practice Address - Phone:847-834-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist