Provider Demographics
NPI:1164501599
Name:BROUGHTON-TEDROW, RACHEL LORIE-ANN (LMT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LORIE-ANN
Last Name:BROUGHTON-TEDROW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 E FRANCIS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-2749
Mailing Address - Country:US
Mailing Address - Phone:509-484-6788
Mailing Address - Fax:
Practice Address - Street 1:1727 E FRANCIS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-2749
Practice Address - Country:US
Practice Address - Phone:509-484-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020442174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist