Healthcare Provider Details

I. General information

NPI: 1578287041
Provider Name (Legal Business Name): ALYSIA SARA BEIRNE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

IV. Provider business mailing address

2500 S 5TH AVE
NORTH RIVERSIDE IL
60546-1223
US

V. Phone/Fax

Practice location:
  • Phone: 708-493-0299
  • Fax:
Mailing address:
  • Phone: 708-616-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070026901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: