Provider Demographics
NPI:1194909150
Name:TY, ALEXANDER PANTOJA (PT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:PANTOJA
Last Name:TY
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 1:1585 BARRINGTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1090
Mailing Address - Country:US
Mailing Address - Phone:847-884-7771
Mailing Address - Fax:847-884-0666
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:STE 101
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1090
Practice Address - Country:US
Practice Address - Phone:847-884-7771
Practice Address - Fax:847-884-0666
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist