Provider Demographics
NPI:1922282169
Name:RAAB, MARY ANNE (PHYSCIAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:RAAB
Suffix:
Gender:F
Credentials:PHYSCIAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST JOHN'S HOSPITAL
Mailing Address - Street 2:800 EAST CARPENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62769-0001
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:217-757-6545
Practice Address - Street 1:ST JOHN'S HOSPITAL
Practice Address - Street 2:800 EAST CARPENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:217-757-6545
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics