Provider Demographics
NPI:1275912677
Name:EBBESSON, RACHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:EBBESSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:VERDUGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 74058
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-4058
Mailing Address - Country:US
Mailing Address - Phone:907-347-4580
Mailing Address - Fax:
Practice Address - Street 1:3180 PEGER RD STE 108
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5484
Practice Address - Country:US
Practice Address - Phone:907-347-4580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist