Provider Demographics
NPI:1235516295
Name:CABRERA, RACQUEL (ATC)
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAMPUS BOX 2660
Mailing Address - Street 2:110 HORTON FIELDHOUSE
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61709-2660
Mailing Address - Country:US
Mailing Address - Phone:309-438-0648
Mailing Address - Fax:
Practice Address - Street 1:110 HORTON FIELDHOUSE
Practice Address - Street 2:ILLINOIS STATE UNIVERSITY ATHLETIC TRAINING
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61709-2660
Practice Address - Country:US
Practice Address - Phone:309-438-0647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0046002255A2300X
VA01260022952255A2300X
IN36002187A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer