Provider Demographics
NPI:1346580859
Name:DANILYUK, RACHAEL L (PTA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:L
Last Name:DANILYUK
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 1:140 DIAMOND CREEK PL STE 125
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7188
Mailing Address - Country:US
Mailing Address - Phone:916-206-3612
Mailing Address - Fax:916-596-4062
Practice Address - Street 1:140 DIAMOND CREEK PL STE 125
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7188
Practice Address - Country:US
Practice Address - Phone:916-206-3612
Practice Address - Fax:916-596-4062
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60324472225200000X
CAPTA49265225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant