Provider Demographics
NPI:1346445061
Name:GADDIS, RACHEL R (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:R
Last Name:GADDIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-1431
Mailing Address - Country:US
Mailing Address - Phone:765-552-1061
Mailing Address - Fax:765-552-8470
Practice Address - Street 1:1331 S A ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1942
Practice Address - Country:US
Practice Address - Phone:756-552-8460
Practice Address - Fax:765-552-8470
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001468A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant