Provider Demographics
NPI:1134700354
Name:AMADOR, RACHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:AMADOR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 SANCTUARY CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2107
Mailing Address - Country:US
Mailing Address - Phone:301-802-6614
Mailing Address - Fax:
Practice Address - Street 1:2101 MEDICAL PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-593-6768
Practice Address - Fax:301-681-7377
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2688225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant