Provider Demographics
NPI:1437505716
Name:BREYFOGLE, RACHAEL ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:BREYFOGLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N 4TH ST
Mailing Address - Street 2:STE D
Mailing Address - City:MAPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51034-1033
Mailing Address - Country:US
Mailing Address - Phone:712-882-6134
Mailing Address - Fax:
Practice Address - Street 1:114 N 4TH ST
Practice Address - Street 2:STE D
Practice Address - City:MAPLETON
Practice Address - State:IA
Practice Address - Zip Code:51034-1033
Practice Address - Country:US
Practice Address - Phone:712-882-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist