Individual
DR. ALISSA RECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 661-8107
Mailing address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 661-8107
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070022820
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070022820
STATE OF ILLINOIS LICENSE NUMBER
IL
01
—
225100000X
TAXONOMY CODE
—
Enumeration date
02/17/2017
Last updated
02/17/2017
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