Provider Demographics
NPI:1053868406
Name:HERZBERGER, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HERZBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26440 S WATERFORD TRL
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5605
Mailing Address - Country:US
Mailing Address - Phone:815-514-4011
Mailing Address - Fax:
Practice Address - Street 1:26440 S WATERFORD TRL
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5605
Practice Address - Country:US
Practice Address - Phone:815-514-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer