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General NPI Number Information
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NPI Number | 1023726668
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Entity Type | Individual
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Provider Name | RAFAEL VICTOR S DE VEYRA PT
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Gender | Male
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 9933 LAWLER AVE STE 206B
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City | SKOKIE
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State | IL
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Zip | 60077-3703
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Country | US
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Telephone | 847-983-8841
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Fax | 888-401-3644
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Provider Business Mailing Address
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Address Line | 1708 LUNT AVE
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City | DES PLAINES
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State | IL
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Zip | 60018-3839
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Country | US
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Telephone | 773-733-8577
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Fax | 888-401-3644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070014035
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License Number State | IL
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