Healthcare Provider Details

I. General information

NPI: 1922579978
Provider Name (Legal Business Name): ALISHA COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 E 71ST ST
CHICAGO IL
60649-2612
US

IV. Provider business mailing address

1340 S MICHIGAN AVE APT 705
CHICAGO IL
60605-2611
US

V. Phone/Fax

Practice location:
  • Phone: 773-721-5000
  • Fax:
Mailing address:
  • Phone: 773-647-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number070016420
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: