=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154342798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALESSANDRO MARCO ANTONINI PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 09/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 337 75TH ST
-----------------------------------------------------
City | DARIEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-789-0004
-----------------------------------------------------
Fax | 630-789-0095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24014 W RENWICK RD 2ND FLOOR SUITE F
-----------------------------------------------------
City | PLAINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60544-8708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-577-2480
-----------------------------------------------------
Fax | 815-487-4550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070016012
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------