Provider Demographics
NPI:1821490616
Name:IWATA, RACHEL (RPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:IWATA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 SEAL BEACH BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2763
Mailing Address - Country:US
Mailing Address - Phone:562-493-8800
Mailing Address - Fax:562-493-2980
Practice Address - Street 1:12501 SEAL BEACH BLVD
Practice Address - Street 2:STE 210
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2763
Practice Address - Country:US
Practice Address - Phone:562-493-8800
Practice Address - Fax:562-493-2980
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT41616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist