Provider Demographics
NPI:1467739649
Name:MAI, RACHELLE JENE (PTA)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:JENE
Last Name:MAI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 MERCERSBURG CV
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1341
Mailing Address - Country:US
Mailing Address - Phone:901-854-6222
Mailing Address - Fax:
Practice Address - Street 1:1536 APPLING CARE LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4927
Practice Address - Country:US
Practice Address - Phone:901-385-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000004839225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant