Basic Information
| Provider Information | |||||||||
| NPI: | 1861683393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | ALISON | ||||||||
| MiddleName: | FRASOR | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FRASOR | ||||||||
| OtherFirstName: | ALISON | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9634 S, PULASKI | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084234800 | ||||||||
| FaxNumber: | 7084234843 | ||||||||
| Practice Location | |||||||||
| Address1: | 9634 S PULASKI RD | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604533391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084234800 | ||||||||
| FaxNumber: | 7084234843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 01/21/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070012049 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 567770 | 01 | IL | MEDICARE GROUP NUMBER | OTHER | 568150 | 01 | IL | MEDICARE GROUP NUMBER | OTHER | 367885100 | 01 | IL | US DEPT OF LABOR PROVIDER | OTHER | 1623066 | 01 | IL | BCBS PROVIDER # | OTHER | CJ4383 | 01 | IL | R.R. MEDICARE GRP # | OTHER | 1619908 | 01 | IL | BCBS OF IL | OTHER | P00224257 | 01 | IL | R.R. MEDICARE PIN # | OTHER |