Provider Demographics
NPI:1588737969
Name:INPHOM, RAVADEE (PT)
Entity type:Individual
Prefix:
First Name:RAVADEE
Middle Name:
Last Name:INPHOM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1010
Mailing Address - Country:US
Mailing Address - Phone:847-251-1231
Mailing Address - Fax:847-251-1231
Practice Address - Street 1:3512 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1010
Practice Address - Country:US
Practice Address - Phone:847-251-1231
Practice Address - Fax:847-251-1231
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25343OtherPHYSICAL THERAPIST