MEDICARE: RACHEL RENEE THOMAS DPT

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	070.028699	IL

General Provider Information

NPI Number	:	1578381695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL RENEE THOMAS DPT

Provider Business Mailing Address
First Line	:	1362 ROOT ST
Second Line	:
City	:	CREST HILL
State	:	IL
Zip	:	60403-0957
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 W DIVISION ST UNIT C-1E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4086
Country	:	US
Telephone Number	:	773-278-9050
Fax Number	:

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

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	09/27/2024

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