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General NPI Number Information
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NPI Number | 1174990055
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Entity Type | Individual
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Provider Name | ALEXANDRA BATTISTONI RUSSELL DPT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 939 BURLINGTON AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4884
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Country | US
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Telephone | 630-963-8505
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Fax | 630-963-8495
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 866-370-8206
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Fax | 517-435-3670
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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 | 070021752
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License Number State | IL
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