Provider Demographics
NPI:1902403967
Name:STORTI, RACHELLE LYNN (MT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LYNN
Last Name:STORTI
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8762
Mailing Address - Country:US
Mailing Address - Phone:603-727-2970
Mailing Address - Fax:
Practice Address - Street 1:1451 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-8762
Practice Address - Country:US
Practice Address - Phone:603-727-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist