Provider Demographics
NPI:1689228926
Name:KOEBELE, RACHEL NYLEEN (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:NYLEEN
Last Name:KOEBELE
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 1:424 STATEN AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3718 GRAND AVE STE 15
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1544
Practice Address - Country:US
Practice Address - Phone:510-893-8878
Practice Address - Fax:510-893-8879
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist