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General NPI Number Information
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NPI Number | 1659075109
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Entity Type | Individual
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Provider Name | ALECSANDER DUTKO
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Gender | Male
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 62 CHERRY TREE SHOPPING CTR
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City | WASHINGTON
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State | IL
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Zip | 61571-2170
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Country | US
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Telephone | 309-481-3081
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Fax | 309-481-3083
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Provider Business Mailing Address
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Address Line | PO BOX 416501
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City | BOSTON
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State | MA
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Zip | 02241-7594
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Country | US
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Telephone | 914-294-4050
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Fax | 631-760-8306
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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 | 070027289
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License Number State | IL
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