Active NPI
Mackenzie Riebel
- Physical Therapist
- Skokie, IL
National Provider Identifier
1629477187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.020789
- Practice address
- 4711 Golf Rd Ste 403
Skokie, IL 60076-1242 - Phone
- (847) 674-2630
- Fax
- (847) 674-4042
- NPI assigned
- Aug 20, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.020789 | IL | Primary |
Addresses
Primary practice location
4711 Golf Rd Ste 403
Skokie, IL 60076-1242
Mailing address
2705 N Rustic Ridge Dr
Peoria, IL 61604-2012
Phone (309) 360-0876
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.020789 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408492800000",
"number": "1629477187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2705 N RUSTIC RIDGE DR",
"city": "PEORIA",
"state": "IL",
"postal_code": "616042012",
"telephone_number": "309-360-0876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4711 GOLF RD STE 403",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600761242",
"telephone_number": "847-674-2630",
"fax_number": "847-674-4042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIEBEL",
"first_name": "MACKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-20",
"last_updated": "2014-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.020789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.