Provider Demographics
NPI:1265725063
Name:BANCEL, ALEXA (PT)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:BANCEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 N GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1307
Mailing Address - Country:US
Mailing Address - Phone:312-909-1510
Mailing Address - Fax:773-694-4841
Practice Address - Street 1:4754 N LINCOLN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7256
Practice Address - Country:US
Practice Address - Phone:772-564-9941
Practice Address - Fax:773-694-4841
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-018401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist