Provider Demographics
NPI:1255873980
Name:PATEL, RADHIKA (PT,MS)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 W FLOURNOY ST
Mailing Address - Street 2:APT 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3550
Mailing Address - Country:US
Mailing Address - Phone:312-478-9369
Mailing Address - Fax:
Practice Address - Street 1:411 N RANDALL RD
Practice Address - Street 2:SUITE F
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6335
Practice Address - Country:US
Practice Address - Phone:847-854-9754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist