Provider Demographics
NPI:1659025062
Name:LONG, RACHEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11850 BLACKFOOT ST NW STE 400
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2776
Mailing Address - Country:US
Mailing Address - Phone:763-236-8911
Mailing Address - Fax:763-236-8930
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 400
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2776
Practice Address - Country:US
Practice Address - Phone:763-236-8911
Practice Address - Fax:763-236-8930
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist