Provider Demographics
NPI:1326299876
Name:LECLERCQ, RACHEL TERESA LECLERCQ (PT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:TERESA LECLERCQ
Last Name:LECLERCQ
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:TERESA
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:280 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5903
Practice Address - Country:US
Practice Address - Phone:847-854-8219
Practice Address - Fax:815-756-1841
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist