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NPI Code Detail

MEDICARE: ALEXIS JULIE LIBRE CHAN

MEDICARE: ALEXIS JULIE LIBRE CHAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistIL

General Provider Information

NPI Number : 1568564144
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS JULIE LIBRE CHAN
Provider Business Mailing Address
First Line : 12553 MEADOW CIR
Second Line :
City : LAKE BLUFF
State : IL
Zip : 60044-1173
Country : US
Telephone Number : 847-482-9422
Fax Number :
Provider Business Practice Location Address
First Line : 3001 GREEN BAY RD
Second Line :
City : NORTH CHICAGO
State : IL
Zip : 60064-3048
Country : US
Telephone Number : 847-688-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2006
Last Update Date : 07/08/2007

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Directions to “ ALEXIS JULIE LIBRE CHAN ” Practice Location

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