Basic Information
| Provider Information | |||||||||
| NPI: | 1871269811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALENZUELA | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1644 N MILWAUKEE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606475412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732522300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1644 N MILWAUKEE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606475412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2246169936 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2021 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.