Provider Demographics
NPI:1366868895
Name:THOMPSON, RACHAEL ELIZABETH (CMT)
Entity Type:Individual
Prefix:MISS
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 S GLADSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-2607
Mailing Address - Country:US
Mailing Address - Phone:574-287-4481
Mailing Address - Fax:
Practice Address - Street 1:454 S GLADSTONE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-2607
Practice Address - Country:US
Practice Address - Phone:574-344-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20902599225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist