1053590216 NPI number — GRACE SHEILA RACADIO PHYSICAL THERAPIST

Table of content: GRACE SHEILA RACADIO PHYSICAL THERAPIST (NPI 1053590216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053590216 NPI number — GRACE SHEILA RACADIO PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RACADIO
Provider First Name:
GRACE
Provider Middle Name:
SHEILA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUIRANTE
Provider Other First Name:
GRACE
Provider Other Middle Name:
SHEILA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053590216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12021 S HARLEM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALOS HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60463-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-923-1768
Provider Business Mailing Address Fax Number:
708-923-1773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12021 S HARLEM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOS HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60463-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-923-1768
Provider Business Practice Location Address Fax Number:
708-923-1773
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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