Provider Demographics
NPI:1003213984
Name:MERVINE, RACHAEL LYNNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNNE
Last Name:MERVINE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HERMANN DR
Mailing Address - Street 2:UNIT 1112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7140
Mailing Address - Country:US
Mailing Address - Phone:413-627-1239
Mailing Address - Fax:
Practice Address - Street 1:1615 HERMANN DR
Practice Address - Street 2:UNIT 1112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7140
Practice Address - Country:US
Practice Address - Phone:413-627-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1245451225100000X
DCPT871541225100000X
VA2305208278225100000X
MA21416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist