Provider Demographics
NPI:1518635580
Name:MLADUCKY, REBECCA ROSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE
Last Name:MLADUCKY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST STE 1450
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3947
Mailing Address - Country:US
Mailing Address - Phone:312-695-7746
Mailing Address - Fax:312-694-6387
Practice Address - Street 1:259 E ERIE ST STE 1450
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3947
Practice Address - Country:US
Practice Address - Phone:312-695-7746
Practice Address - Fax:312-694-6387
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070026187225100000X
IL070.026187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist