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General NPI Number Information
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NPI Number | 1225770514
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Entity Type | Individual
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Provider Name | ALYSSA STEVENS PTA
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Gender | Female
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 7543 183RD ST
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City | TINLEY PARK
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State | IL
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Zip | 60477-6208
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Country | US
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Telephone | 708-390-3362
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Fax |
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Provider Business Mailing Address
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Address Line | 17049 LORENZ AVE
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City | LANSING
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State | IL
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Zip | 60438-1130
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Country | US
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Telephone | 708-986-7690
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.0078398
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License Number State | IL
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