Provider Demographics
NPI:1467669812
Name:RAFAEL, BASMA K
Entity Type:Individual
Prefix:
First Name:BASMA
Middle Name:K
Last Name:RAFAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8325
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-8325
Mailing Address - Country:US
Mailing Address - Phone:847-722-8472
Mailing Address - Fax:847-397-6132
Practice Address - Street 1:2307 JOSEPHINE CT
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-7282
Practice Address - Country:US
Practice Address - Phone:847-722-8472
Practice Address - Fax:847-397-6132
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist