Provider Demographics
NPI:1861683393
Name:MYERS, ALISON FRASOR (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:FRASOR
Last Name:MYERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ALISON
Other - Middle Name:MARIE
Other - Last Name:FRASOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9634 S, PULASKI
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-423-4800
Mailing Address - Fax:708-423-4843
Practice Address - Street 1:9634 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3391
Practice Address - Country:US
Practice Address - Phone:708-423-4800
Practice Address - Fax:708-423-4843
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL567770OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IL367885100OtherUS DEPT OF LABOR PROVIDER
IL1623066OtherBCBS PROVIDER #
ILCJ4383OtherR.R. MEDICARE GRP #
IL1619908OtherBCBS OF IL
ILP00224257OtherR.R. MEDICARE PIN #
IL568150OtherMEDICARE GROUP NUMBER