Provider Demographics
NPI:1285726968
Name:SCHURICHT, STEPHANIE A (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SCHURICHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:PEQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:847-929-1154
Practice Address - Street 1:11222 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8208
Practice Address - Country:US
Practice Address - Phone:708-326-0298
Practice Address - Fax:708-326-0299
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00875225OtherMEDICARE RAILROAD
ILK35884Medicare PIN
ILP00388235Medicare PIN
ILK09860Medicare PIN
ILP00875225OtherMEDICARE RAILROAD