Provider Demographics
NPI:1659414324
Name:CANNELLA, RACHELLE (PT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:CANNELLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:WINTERROWD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:
Practice Address - Street 1:10940 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7980
Practice Address - Country:US
Practice Address - Phone:765-442-4200
Practice Address - Fax:765-442-4201
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008741225100000X
IN05007430A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist