MEDICARE: RACHEL MARIE FULLER PT, 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	070.029602	IL

General Provider Information

NPI Number	:	1861338360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL MARIE FULLER PT, DPT

Provider Business Mailing Address
First Line	:	5331 N LUDLAM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5331 N LUDLAM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1411
Country	:	US
Telephone Number	:	312-961-3574
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	05/23/2026

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