Provider Demographics
NPI:1508346412
Name:WIESENFELD, RACHEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WIESENFELD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 71ST RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4905
Mailing Address - Country:US
Mailing Address - Phone:718-263-9011
Mailing Address - Fax:
Practice Address - Street 1:11020 71ST RD STE 101
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4905
Practice Address - Country:US
Practice Address - Phone:718-263-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295401225100000X
NY044283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist