Provider Demographics
NPI:1144940933
Name:THEANCHAI, CHERRYL RAFAEL (DPT)
Entity type:Individual
Prefix:DR
First Name:CHERRYL
Middle Name:RAFAEL
Last Name:THEANCHAI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:CHERRYL
Other - Middle Name:ILAYA
Other - Last Name:RAFAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:101 POINTE DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 REVERE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-412-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist