Provider Demographics
NPI:1851425854
Name:MIGUEL, RACHEL DIZON (PT)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:DIZON
Last Name:MIGUEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W NORTHWEST ST
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:47991-8048
Mailing Address - Country:US
Mailing Address - Phone:217-784-8033
Mailing Address - Fax:
Practice Address - Street 1:109 N SANGAMON AVE
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1342
Practice Address - Country:US
Practice Address - Phone:217-784-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70009050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist