Provider Demographics
NPI:1336717503
Name:ARDOVITCH, ALEXIS MARIE (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:MARIE
Last Name:ARDOVITCH
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 CRESS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1215
Mailing Address - Country:US
Mailing Address - Phone:630-724-7347
Mailing Address - Fax:
Practice Address - Street 1:1484 CRESS CREEK CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1215
Practice Address - Country:US
Practice Address - Phone:630-724-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
NC2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic