Provider Demographics
NPI:1700436755
Name:LOY, ALEXANDRA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:LOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 E 2900 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60912-7051
Mailing Address - Country:US
Mailing Address - Phone:815-216-8742
Mailing Address - Fax:
Practice Address - Street 1:2803 E 2900 NORTH RD
Practice Address - Street 2:
Practice Address - City:BEAVERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60912-7051
Practice Address - Country:US
Practice Address - Phone:815-216-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist