Provider Demographics
NPI:1356777858
Name:TREVOR, ALEXANDER J (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:J
Last Name:TREVOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E DEERPATH
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1952
Mailing Address - Country:US
Mailing Address - Phone:847-482-1433
Mailing Address - Fax:847-482-1483
Practice Address - Street 1:225 E DEERPATH
Practice Address - Street 2:SUITE 130
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1952
Practice Address - Country:US
Practice Address - Phone:847-482-1433
Practice Address - Fax:847-482-1483
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-020302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist