Provider Demographics
NPI:1598366874
Name:STOFFREGEN, RACHEL LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAUREN
Last Name:STOFFREGEN
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:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:1255 W EXCHANGE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7112
Practice Address - Country:US
Practice Address - Phone:469-421-1837
Practice Address - Fax:469-722-7841
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1333302225100000X
IL070.025275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty