Provider Demographics
NPI:1831103332
Name:RALPH, MICHELLE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:RALPH
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 1:6948 BENNINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-855-2993
Mailing Address - Fax:
Practice Address - Street 1:801 S MILWAUKEE
Practice Address - Street 2:CONDELL MEDICAL CENTER CONDELL DRIVE
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60042-3199
Practice Address - Country:US
Practice Address - Phone:847-990-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
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