Provider Demographics
NPI:1295119469
Name:RACKY, BRIDGET (PTA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:RACKY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 DERBY LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-3749
Mailing Address - Country:US
Mailing Address - Phone:708-681-2991
Mailing Address - Fax:708-731-3173
Practice Address - Street 1:2600 S MICHIGAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2857
Practice Address - Country:US
Practice Address - Phone:312-326-7492
Practice Address - Fax:312-326-7490
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist