Provider Demographics
NPI:1336259068
Name:RAFTIS, THEMISTOCLES (PT)
Entity Type:Individual
Prefix:
First Name:THEMISTOCLES
Middle Name:
Last Name:RAFTIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 S WABASH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2491
Mailing Address - Country:US
Mailing Address - Phone:312-842-4600
Mailing Address - Fax:
Practice Address - Street 1:353 E BURLINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2082
Practice Address - Country:US
Practice Address - Phone:708-442-0221
Practice Address - Fax:708-442-5670
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859017Medicare PIN