Provider Demographics
NPI:1649716929
Name:PECK, ALEXANDRA (DPT, PT)
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:FRANCESCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:305 E. SCRANTON AVE.
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044
Mailing Address - Country:US
Mailing Address - Phone:925-683-2306
Mailing Address - Fax:
Practice Address - Street 1:305 E. SCRANTON AVE.
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044
Practice Address - Country:US
Practice Address - Phone:925-683-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070025036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist