Provider Demographics
NPI:1558036046
Name:WISMETH-JOHNSTON, RACHEL NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:WISMETH-JOHNSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 AMERICAN PACIFIC DR APT 7308
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7614
Mailing Address - Country:US
Mailing Address - Phone:425-306-3568
Mailing Address - Fax:
Practice Address - Street 1:9260 W SUNSET RD STE 204
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4903
Practice Address - Country:US
Practice Address - Phone:702-339-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist