Provider Demographics
NPI:1932347234
Name:VALENCIA-UNTERBRUNNER, ALICIA E (PT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:E
Last Name:VALENCIA-UNTERBRUNNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:E
Other - Last Name:VALENCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1233 W ADAMS ST STE 1020
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2801
Mailing Address - Country:US
Mailing Address - Phone:312-243-8487
Mailing Address - Fax:
Practice Address - Street 1:1921 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2407
Practice Address - Country:US
Practice Address - Phone:312-243-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11157-24225100000X
IL070018545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932347234Medicaid
IL$$$$$$$$$1 1Medicaid
WI541760606Medicare PIN