Provider Demographics
NPI:1558946483
Name:RYBITSKYI, YAREMA
Entity Type:Individual
Prefix:
First Name:YAREMA
Middle Name:
Last Name:RYBITSKYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:
Other - Last Name:REMMY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:111 AUTUMN CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1581
Mailing Address - Country:US
Mailing Address - Phone:847-409-5387
Mailing Address - Fax:
Practice Address - Street 1:1535 LAKE COOK RD STE 102
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1450
Practice Address - Country:US
Practice Address - Phone:773-983-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227000463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist