Provider Demographics
NPI:1497929764
Name:CUSHMAN, RACHEL KATHRYN (PTA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:KATHRYN
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2932
Mailing Address - Country:US
Mailing Address - Phone:309-692-8110
Mailing Address - Fax:
Practice Address - Street 1:1600 S 4TH AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2889
Practice Address - Country:US
Practice Address - Phone:309-263-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004310225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant