Healthcare Provider Details

I. General information

NPI: 1114334224
Provider Name (Legal Business Name): JENNIFER ALCEDO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W EXECUTIVE DR STE 500
ADDISON IL
60101-5626
US

IV. Provider business mailing address

1839 MAROON BELLS LN
BOLINGBROOK IL
60490-6533
US

V. Phone/Fax

Practice location:
  • Phone: 630-766-0505
  • Fax: 630-766-0855
Mailing address:
  • Phone: 630-269-6518
  • Fax: 630-771-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-007240
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: