Provider Demographics
NPI:1851532253
Name:BARREDO-RAGER, LEAH MAE DEQUITADO (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH MAE
Middle Name:DEQUITADO
Last Name:BARREDO-RAGER
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 1:100 TERRACE VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-1044
Mailing Address - Country:US
Mailing Address - Phone:815-757-6514
Mailing Address - Fax:
Practice Address - Street 1:1234 S PARK BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4602
Practice Address - Country:US
Practice Address - Phone:815-616-5952
Practice Address - Fax:815-616-5953
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL70016978OtherPROFESSIONAL LICENSE