Provider Demographics
NPI:1275747867
Name:STAFFORD, RACHAEL LYNN (PT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNN
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LYNN
Other - Last Name:O'BRYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:601 ROCKMEAD DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2107
Mailing Address - Country:US
Mailing Address - Phone:713-814-2530
Mailing Address - Fax:713-704-3844
Practice Address - Street 1:601 ROCKMEAD DRIVE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-5115
Practice Address - Fax:281-312-3831
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194470225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist