Provider Demographics
NPI:1619944535
Name:RAINE, SUSAN WAHL (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:WAHL
Last Name:RAINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 WARWICK LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2797
Mailing Address - Country:US
Mailing Address - Phone:847-726-0439
Mailing Address - Fax:
Practice Address - Street 1:301 E RAND RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6089
Practice Address - Country:US
Practice Address - Phone:847-398-1775
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist