Provider Demographics
NPI:1346202611
Name:PROULX, RACHEL ANDIE SIMON (MPT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANDIE SIMON
Last Name:PROULX
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8003 RURAL RETREAT CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3917
Mailing Address - Country:US
Mailing Address - Phone:407-234-2301
Mailing Address - Fax:407-264-9724
Practice Address - Street 1:8003 RURAL RETREAT CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3917
Practice Address - Country:US
Practice Address - Phone:407-234-2301
Practice Address - Fax:407-264-9724
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT178362251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics