Provider Demographics
NPI:1154342798
Name:ANTONINI, ALESSANDRO MARCO (PT)
Entity type:Individual
Prefix:
First Name:ALESSANDRO
Middle Name:MARCO
Last Name:ANTONINI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24014 W RENWICK RD
Mailing Address - Street 2:2ND FLOOR SUITE F
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8708
Mailing Address - Country:US
Mailing Address - Phone:815-577-2480
Mailing Address - Fax:815-487-4550
Practice Address - Street 1:337 75TH ST
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:630-789-0004
Practice Address - Fax:630-789-0095
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP NUMBER
IL1623066OtherBCBS GROUP #
IL367885100OtherU.S. DEPT OF LABOR
IL567770OtherMEDICARE GROUP #
IL568080OtherMEDICARE GROUP NUMBER
IL200852OtherMEDICARE GROUP #
IL202542OtherMEDICARE GROUP #