Provider Demographics
NPI:1780815530
Name:DEBLOIS, RACHEL BETH (PTA/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:BETH
Last Name:DEBLOIS
Suffix:
Gender:F
Credentials:PTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RICHMOND SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-4172
Practice Address - Street 1:1401 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4058
Practice Address - Country:US
Practice Address - Phone:401-433-4172
Practice Address - Fax:401-433-0612
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20591225100000X
MA7983225200000X
RIPT02880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant