Provider Demographics
NPI:1407304801
Name:HINES, RACHAEL (PT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 EAST LAKE BLVD.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-2129
Mailing Address - Country:US
Mailing Address - Phone:228-392-9355
Mailing Address - Fax:228-546-3240
Practice Address - Street 1:1720A MEDICAL PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2129
Practice Address - Country:US
Practice Address - Phone:228-546-3266
Practice Address - Fax:228-546-3240
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist