Provider Demographics
NPI:1639495138
Name:GO, RAECHEL (PT)
Entity Type:Individual
Prefix:
First Name:RAECHEL
Middle Name:
Last Name:GO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 HUNTSPOINT WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2535
Mailing Address - Country:US
Mailing Address - Phone:270-315-6471
Mailing Address - Fax:
Practice Address - Street 1:4255 MEDWEL DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2528
Practice Address - Country:US
Practice Address - Phone:812-853-2993
Practice Address - Fax:812-853-8847
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009256A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist