Provider Demographics
NPI:1114365707
Name:PANOSIAN, RACHEL CORNISH (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:CORNISH
Last Name:PANOSIAN
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 1:5855 E STAPLETON DR N
Mailing Address - Street 2:# 130
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3318
Mailing Address - Country:US
Mailing Address - Phone:303-371-7444
Mailing Address - Fax:
Practice Address - Street 1:5855 E STAPLETON DR N
Practice Address - Street 2:# 130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3318
Practice Address - Country:US
Practice Address - Phone:303-371-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012185225100000X
UT8539716-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist