Provider Demographics
NPI:1710559604
Name:PETRELLA, RACHEL ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:PETRELLA
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 1:18225 DETROIT AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3347
Mailing Address - Country:US
Mailing Address - Phone:440-985-8962
Mailing Address - Fax:
Practice Address - Street 1:3428 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3339
Practice Address - Country:US
Practice Address - Phone:330-668-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist