Provider Demographics
NPI:1083127385
Name:JESPERSEN, RACHEL COLLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:COLLEEN
Last Name:JESPERSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1230
Mailing Address - Country:US
Mailing Address - Phone:410-833-3025
Mailing Address - Fax:240-575-9380
Practice Address - Street 1:801 TOLL HOUSE AVE STE H3
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6117
Practice Address - Country:US
Practice Address - Phone:240-575-9260
Practice Address - Fax:240-575-9380
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist