Provider Demographics
NPI:1275867442
Name:DECAMP, RACHELLE ANDREE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:ANDREE
Last Name:DECAMP
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:RACHELLE
Other - Middle Name:ANDREE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT DPT
Mailing Address - Street 1:230 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7100
Mailing Address - Country:US
Mailing Address - Phone:518-593-8522
Mailing Address - Fax:
Practice Address - Street 1:230 ALLEN RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7100
Practice Address - Country:US
Practice Address - Phone:518-593-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62031797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist