Provider Demographics
NPI:1003136482
Name:BUIVIDS, RACHEL REBECCA (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:REBECCA
Last Name:BUIVIDS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8125
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8125
Mailing Address - Country:US
Mailing Address - Phone:714-754-7268
Mailing Address - Fax:714-434-7042
Practice Address - Street 1:17272 NEWHOPE ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4210
Practice Address - Country:US
Practice Address - Phone:714-754-7268
Practice Address - Fax:714-434-7042
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist