Provider Demographics
NPI:1487185872
Name:PETRBOK, RACHEL E (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:PETRBOK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:E
Other - Last Name:MCKANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:11215 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4416
Practice Address - Country:US
Practice Address - Phone:773-938-8500
Practice Address - Fax:773-938-8501
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
070-023043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist