Provider Demographics
NPI:1104840297
Name:KOEBEL, RACHEL TORGERSON (PT, MPT, GCS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:TORGERSON
Last Name:KOEBEL
Suffix:
Gender:F
Credentials:PT, MPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:S MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2350 N LAKE DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-296-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6507024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI$$$$$$$$$004OtherBCBS