Provider Demographics
NPI:1780899864
Name:DONOHUE, NICOLE RADEK (PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RADEK
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:RADEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3846 N LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4115
Mailing Address - Country:US
Mailing Address - Phone:773-732-5280
Mailing Address - Fax:773-279-9136
Practice Address - Street 1:8833 GROSS POINT RD
Practice Address - Street 2:SUITE 308
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1859
Practice Address - Country:US
Practice Address - Phone:847-674-2630
Practice Address - Fax:847-674-4042
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist