Provider Demographics
NPI:1801377445
Name:CRIMMINS, RACHAEL LEE
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LEE
Last Name:CRIMMINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 CIRCUIT ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2013
Mailing Address - Country:US
Mailing Address - Phone:617-413-6837
Mailing Address - Fax:
Practice Address - Street 1:215 THATCHER ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3949
Practice Address - Country:US
Practice Address - Phone:617-413-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist