Provider Demographics
NPI:1487228789
Name:CABRERA, RUSSEL RAYMUND YAP (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:RUSSEL RAYMUND
Middle Name:YAP
Last Name:CABRERA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 N CICERO AVE APT 417
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3448
Mailing Address - Country:US
Mailing Address - Phone:312-813-1816
Mailing Address - Fax:
Practice Address - Street 1:4632 CHURCH ST STE 101
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1545
Practice Address - Country:US
Practice Address - Phone:847-768-1050
Practice Address - Fax:847-768-1064
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty