Provider Demographics
NPI:1023613551
Name:ALZONA, ALEXIS ALINA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ALINA
Last Name:ALZONA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15224 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3739
Mailing Address - Country:US
Mailing Address - Phone:708-577-0208
Mailing Address - Fax:
Practice Address - Street 1:5556 W 77TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1398
Practice Address - Country:US
Practice Address - Phone:708-577-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0048272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer