Provider Demographics
NPI:1982996260
Name:RIETVELD, RACHEL ELIZABETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:RIETVELD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:406 FRONT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5593
Mailing Address - Country:US
Mailing Address - Phone:815-344-8706
Mailing Address - Fax:815-344-8793
Practice Address - Street 1:406 FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5593
Practice Address - Country:US
Practice Address - Phone:815-344-8706
Practice Address - Fax:815-344-8793
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist