Provider Demographics
NPI:1851813976
Name:LOMBARDO, RACHELLE S (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:S
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 BELVEDERE CIR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1172
Mailing Address - Country:US
Mailing Address - Phone:850-607-4830
Mailing Address - Fax:
Practice Address - Street 1:9400 UNIVERSITY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5485
Practice Address - Country:US
Practice Address - Phone:850-208-6120
Practice Address - Fax:850-208-6129
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22688225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant