Provider Demographics
NPI:1497850044
Name:MIKA, RACHEL Z (PT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:Z
Last Name:MIKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6619 MOUNTAIN RIDGE PASS
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2844
Mailing Address - Country:US
Mailing Address - Phone:630-544-9442
Mailing Address - Fax:815-600-7986
Practice Address - Street 1:6619 MOUNTAIN RIDGE PASS
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586
Practice Address - Country:US
Practice Address - Phone:630-544-9442
Practice Address - Fax:815-600-7986
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid