Provider Demographics
NPI:1811470578
Name:KRAVCHAK, RACHAEL
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:KRAVCHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:HOGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:2022 WINDWARD LN STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7418
Practice Address - Country:US
Practice Address - Phone:770-415-0011
Practice Address - Fax:770-783-0321
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1649308156OtherGROUP NPI