Healthcare Provider Details

I. General information

NPI: 1124417563
Provider Name (Legal Business Name): ALYSSA TOEBBEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA THOMPSON DPT

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 W 95TH ST
OAK LAWN IL
60453-2450
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 708-488-1408
  • Fax:
Mailing address:
  • Phone: 630-296-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.021307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: