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General NPI Number Information
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NPI Number | 1073427449
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Entity Type | Individual
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Provider Name | ALEXIS LYNN PULTORAK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 18410 GOVERNORS HWY
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City | HOMEWOOD
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State | IL
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Zip | 60430-2911
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Country | US
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Telephone | 708-852-2535
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Fax |
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Provider Business Mailing Address
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Address Line | 4064 W 115TH ST APT 8-201
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City | CHICAGO
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State | IL
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Zip | 60655-4360
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070040368
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License Number State | IL
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