Provider Demographics
NPI:1730576026
Name:BERNAL, ALVIN (PT)
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:
Last Name:BERNAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16170 KINGSPORT RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5602
Mailing Address - Country:US
Mailing Address - Phone:708-326-1550
Mailing Address - Fax:708-326-1557
Practice Address - Street 1:120 DODGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3622
Practice Address - Country:US
Practice Address - Phone:847-869-7744
Practice Address - Fax:847-570-0112
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist