Provider Demographics
NPI:1033612643
Name:HUSS, RACHEL MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:HUSS
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 1:4325 MEADOWSWEET LN NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8615
Mailing Address - Country:US
Mailing Address - Phone:810-513-6965
Mailing Address - Fax:
Practice Address - Street 1:111 LAKESIDE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3811
Practice Address - Country:US
Practice Address - Phone:616-588-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015266OtherPT LICENSE