Provider Demographics
NPI:1023095650
Name:BULLAR, RACHEL NICOLE (PT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:NICOLE
Last Name:BULLAR
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 1:1221 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1404
Mailing Address - Country:US
Mailing Address - Phone:630-859-8700
Mailing Address - Fax:630-264-8444
Practice Address - Street 1:1221 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1404
Practice Address - Country:US
Practice Address - Phone:630-859-8700
Practice Address - Fax:630-264-8444
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-013521225100000X
MO2002028046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK35227Medicare PIN
ILK35228Medicare PIN