Provider Demographics
NPI:1699223925
Name:LOVERING FASTERT, ALLISON JANE (PT, DPT, GCS, IADN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JANE
Last Name:LOVERING FASTERT
Suffix:
Gender:F
Credentials:PT, DPT, GCS, IADN
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:LOVERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:24014 W RENWICK RD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8711
Mailing Address - Country:US
Mailing Address - Phone:800-974-4378
Mailing Address - Fax:630-515-1536
Practice Address - Street 1:2500 RIDGE AVE STE 110
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2468
Practice Address - Country:US
Practice Address - Phone:800-974-4378
Practice Address - Fax:630-515-1536
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070022505OtherSTATE LICENSE