Provider Demographics
NPI:1245544469
Name:WISE, RACHEL (DPT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4754 N LINCOLN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7256
Mailing Address - Country:US
Mailing Address - Phone:773-564-9941
Mailing Address - Fax:773-694-4841
Practice Address - Street 1:4754 N LINCOLN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7256
Practice Address - Country:US
Practice Address - Phone:773-694-4841
Practice Address - Fax:773-694-4841
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-017924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist