Provider Demographics
NPI:1780831768
Name:NYGREN, RACHEL ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:NYGREN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:MANDICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5720 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:2221 WANKEL WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0192
Practice Address - Country:US
Practice Address - Phone:805-988-0448
Practice Address - Fax:805-988-3070
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34766OtherSTATE LICENSE