Provider Demographics
NPI:1851070593
Name:MARSHALL, ALEXANDRIA MARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:MARSHALL
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 1:504 W BURLINGTON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2227
Mailing Address - Country:US
Mailing Address - Phone:464-202-7240
Mailing Address - Fax:
Practice Address - Street 1:504 W BURLINGTON AVE STE C
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2227
Practice Address - Country:US
Practice Address - Phone:464-202-7240
Practice Address - Fax:464-202-7241
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist