Healthcare Provider Details

I. General information

NPI: 1730884180
Provider Name (Legal Business Name): RACHEL S SEFAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1366 W FULLERTON AVE
CHICAGO IL
60614-2129
US

IV. Provider business mailing address

5700 N ASHLAND AVE APT 410
CHICAGO IL
60660-0243
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-9300
  • Fax:
Mailing address:
  • Phone: 312-315-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: