Provider Demographics
NPI:1508317629
Name:PATERA, RACHAEL (ATC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:PATERA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5595
Mailing Address - Country:US
Mailing Address - Phone:630-590-5409
Mailing Address - Fax:630-590-5783
Practice Address - Street 1:6901 S MADISON ST
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5595
Practice Address - Country:US
Practice Address - Phone:630-590-5409
Practice Address - Fax:630-590-5783
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960024402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer