Provider Demographics
NPI:1699063222
Name:ALAICHAMY, TARA THANANETAPON (DPT)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:THANANETAPON
Last Name:ALAICHAMY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:THANANETAPON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2610 SHERIDAN ROAD
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099
Mailing Address - Country:US
Mailing Address - Phone:877-884-7346
Mailing Address - Fax:
Practice Address - Street 1:2520 ELISHA AVENUE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:847-731-1605
Practice Address - Fax:847-872-6176
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist