Provider Demographics
NPI:1568736171
Name:DUFF, RHIANNON NICOLE (PTA)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:NICOLE
Last Name:DUFF
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 1:3025 N CALIFORNIA AVE
Mailing Address - Street 2:APT 2SW
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7781
Mailing Address - Country:US
Mailing Address - Phone:618-889-8264
Mailing Address - Fax:
Practice Address - Street 1:3025 N CALIFORNIA AVE
Practice Address - Street 2:APT 2SW
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7781
Practice Address - Country:US
Practice Address - Phone:618-889-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004784225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant