Healthcare Provider Details

I. General information

NPI: 1205308152
Provider Name (Legal Business Name): RACHEL E RICHARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4746 N CUMBERLAND AVE
CHICAGO IL
60656-4239
US

IV. Provider business mailing address

4746 N CUMBERLAND AVE
CHICAGO IL
60656-4239
US

V. Phone/Fax

Practice location:
  • Phone: 773-417-8901
  • Fax: 773-717-5607
Mailing address:
  • Phone: 773-417-8901
  • Fax: 773-717-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070023910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: