Provider Demographics
NPI:1114461878
Name:GEORGE, RACHEL (PTA009666)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PTA009666
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 BURGETT LN
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9312
Mailing Address - Country:US
Mailing Address - Phone:330-259-5735
Mailing Address - Fax:
Practice Address - Street 1:4028 BURGETT LN
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9312
Practice Address - Country:US
Practice Address - Phone:330-259-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009666225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant