Provider Demographics
NPI:1366647653
Name:LIDDICOAT, RACHAEL L (DPT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:L
Last Name:LIDDICOAT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-945-4018
Practice Address - Street 1:10511 19TH AVE SE
Practice Address - Street 2:B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4279
Practice Address - Country:US
Practice Address - Phone:425-357-8885
Practice Address - Fax:425-357-8454
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00010752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8881131OtherMEDICARE
WA8882163OtherMEDICARE
WAG8896032OtherMEDICARE