Provider Demographics
NPI:1902874720
Name:EMANUELSON, ALYSSA (ATC, LGI)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:EMANUELSON
Suffix:
Gender:F
Credentials:ATC, LGI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 PIKE PL
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4780
Mailing Address - Country:US
Mailing Address - Phone:815-252-3471
Mailing Address - Fax:
Practice Address - Street 1:ATI PHYSICAL THERAPY
Practice Address - Street 2:3082 CATON FARM RD
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-577-9936
Practice Address - Fax:815-577-9938
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer