Provider Demographics
NPI:1609174259
Name:KERZEE-STAMATELOPOULOS, ALEKSANDER (DPT)
Entity type:Individual
Prefix:
First Name:ALEKSANDER
Middle Name:
Last Name:KERZEE-STAMATELOPOULOS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S GARY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2200
Mailing Address - Country:US
Mailing Address - Phone:630-933-4550
Mailing Address - Fax:630-933-2200
Practice Address - Street 1:245 S GARY AVE STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2200
Practice Address - Country:US
Practice Address - Phone:630-933-4550
Practice Address - Fax:630-933-2200
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID-2804225100000X
IL070018842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist