Provider Demographics
NPI:1699003491
Name:MERRILL, RACHEL MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10756 CEDAR RUN RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9415
Mailing Address - Country:US
Mailing Address - Phone:616-826-6560
Mailing Address - Fax:
Practice Address - Street 1:4000 EASTERN SKY DR STE 6
Practice Address - Street 2:SUITE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7351
Practice Address - Country:US
Practice Address - Phone:231-932-9014
Practice Address - Fax:231-932-9034
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236697Medicare PIN