Provider Demographics
NPI:1306938972
Name:ENTWHISTLE, ALYSON R (PT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:R
Last Name:ENTWHISTLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:R
Other - Last Name:JIRMASEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:80 TEMPLETON DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7000
Mailing Address - Country:US
Mailing Address - Phone:630-554-3456
Mailing Address - Fax:630-551-2970
Practice Address - Street 1:80 TEMPLETON DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543
Practice Address - Country:US
Practice Address - Phone:630-554-3456
Practice Address - Fax:630-551-2970
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00882382OtherMEDICARE RAILROAD
ILP00931542OtherMEDICARE RAILROAD
ILP00882382OtherMEDICARE RAILROAD
IL216860063Medicare PIN
ILT00105Medicare PIN
ILP00931542OtherMEDICARE RAILROAD
IL209796016Medicare PIN