Healthcare Provider Details

I. General information

NPI: 1154342798
Provider Name (Legal Business Name): ALESSANDRO MARCO ANTONINI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 75TH ST
DARIEN IL
60527
US

IV. Provider business mailing address

24014 W RENWICK RD 2ND FLOOR SUITE F
PLAINFIELD IL
60544-8708
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-0004
  • Fax: 630-789-0095
Mailing address:
  • Phone: 815-577-2480
  • Fax: 815-487-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070016012
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: