Provider Demographics
NPI:1033217203
Name:WILLIAMS, RACHEL NICHOLE (PT)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:NICHOLE
Last Name:WILLIAMS
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 1:3814 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-2358
Mailing Address - Country:US
Mailing Address - Phone:941-723-2866
Mailing Address - Fax:813-622-3886
Practice Address - Street 1:2750 FALKENBURG RD S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-2561
Practice Address - Country:US
Practice Address - Phone:813-622-3885
Practice Address - Fax:813-622-3886
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8249Medicare ID - Type UnspecifiedGROUP ID