Provider Demographics
NPI:1417063348
Name:MARTIN, RACHAEL (PT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3196 155TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-9736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 OVESON DR
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:IA
Practice Address - Zip Code:52778-9612
Practice Address - Country:US
Practice Address - Phone:563-732-4317
Practice Address - Fax:563-732-4318
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA033642251P0200X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic