Provider Demographics
NPI:1255000758
Name:WALLISH, RACHEL M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:WALLISH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:M
Other - Last Name:KENDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
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:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:2619 SW 9TH ST STE 103
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-1910
Practice Address - Country:US
Practice Address - Phone:515-953-6911
Practice Address - Fax:515-953-6913
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA109952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist