MEDICARE: MRS. RACHEL Z MIKA 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
1	225100000X	Physical Therapist	070012466	IL

General Provider Information

NPI Number	:	1497850044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL Z MIKA PT

Provider Business Mailing Address
First Line	:	6619 MOUNTAIN RIDGE PASS
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-2844
Country	:	US
Telephone Number	:	630-544-9442
Fax Number	:	815-600-7986

Provider Business Practice Location Address
First Line	:	6619 MOUNTAIN RIDGE PASS
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586
Country	:	US
Telephone Number	:	630-544-9442
Fax Number	:	815-600-7986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	06/20/2018

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