Provider Demographics
NPI:1063472629
Name:NIXON, RACHEL KELLY (PT)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:KELLY
Last Name:NIXON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KELLY
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3607 NORTH EVERBROOK LANE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304
Mailing Address - Country:US
Mailing Address - Phone:765-741-8390
Mailing Address - Fax:765-741-8219
Practice Address - Street 1:3607 NEVERBROOK LN
Practice Address - Street 2:
Practice Address - City:MUNCEE
Practice Address - State:IN
Practice Address - Zip Code:47304
Practice Address - Country:US
Practice Address - Phone:765-741-8390
Practice Address - Fax:765-741-8219
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001685A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist