Provider Demographics
NPI:1124217989
Name:RIECK, EVA RUTH SALAZAR (PT)
Entity Type:Individual
Prefix:
First Name:EVA RUTH
Middle Name:SALAZAR
Last Name:RIECK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:SALAZAR
Other - Last Name:RIECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:551 CHEYENNE TR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188
Mailing Address - Country:US
Mailing Address - Phone:630-242-0200
Mailing Address - Fax:630-456-4792
Practice Address - Street 1:551 CHEYENNE TRL
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1540
Practice Address - Country:US
Practice Address - Phone:630-242-0200
Practice Address - Fax:630-456-4792
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist