Provider Demographics
NPI:1083087530
Name:HINOJOSA-DERBY, RACHEL MARIE ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE ROSE
Last Name:HINOJOSA-DERBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1459
Mailing Address - Country:US
Mailing Address - Phone:419-873-7653
Mailing Address - Fax:
Practice Address - Street 1:214 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1459
Practice Address - Country:US
Practice Address - Phone:419-873-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021991225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist