Healthcare Provider Details

I. General information

NPI: 1952800518
Provider Name (Legal Business Name): MARIA RABACA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 W OAKMONT RD
HOFFMAN ESTATES IL
60169-1241
US

IV. Provider business mailing address

1563 W OAKMONT RD
HOFFMAN ESTATES IL
60169-1241
US

V. Phone/Fax

Practice location:
  • Phone: 773-329-6401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160004746
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: