Provider Demographics
NPI:1275634883
Name:RACHLIN, MITCHELL (PTA)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:RACHLIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 VIOLET AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3027
Mailing Address - Country:US
Mailing Address - Phone:917-502-0252
Mailing Address - Fax:
Practice Address - Street 1:33 IRVING PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2332
Practice Address - Country:US
Practice Address - Phone:212-677-3989
Practice Address - Fax:212-677-3994
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005247-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant