Provider Demographics
NPI:1114776275
Name:FREEDOM PHYSICAL THERAPY AND FITNESS, PLLC
Entity type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY AND FITNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:217-290-1520
Mailing Address - Street 1:10103 N 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:IL
Mailing Address - Zip Code:62560-5155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10103 N 21ST AVE
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:IL
Practice Address - Zip Code:62560-5155
Practice Address - Country:US
Practice Address - Phone:217-290-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty