Basic Information
| Provider Information | |||||||||
| NPI: | 1063630317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXEYCHUK | ||||||||
| FirstName: | TONI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11531 SWINFORD LN | ||||||||
| Address2: | |||||||||
| City: | MOKENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604489274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2196772461 | ||||||||
| FaxNumber: | 7084792111 | ||||||||
| Practice Location | |||||||||
| Address1: | 11531 SWINFORD LN | ||||||||
| Address2: | |||||||||
| City: | MOKENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604489274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2196772461 | ||||||||
| FaxNumber: | 7084792111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 08/15/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05006226A | IN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251P0200X | 05006226A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225100000X | 70011379 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.