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NPI Code Detail

MEDICARE: MRS. RACHEL ELLEN VEZEAU PT

MEDICARE:  MRS. RACHEL ELLEN VEZEAU  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistIL

General Provider Information

NPI Number : 1164638342
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RACHEL ELLEN VEZEAU PT
Provider Business Mailing Address
First Line : 502 OAK CREST RD
Second Line :
City : CARY
State : IL
Zip : 60013-2358
Country : US
Telephone Number : 847-516-0883
Fax Number :
Provider Business Practice Location Address
First Line : 5150 NORTHWEST HWY
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-8058
Country : US
Telephone Number : 815-455-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. RACHEL ELLEN VEZEAU PT” Practice Location

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