Provider Demographics
NPI:1932685492
Name:MASSENGILL, RACHEL (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MASSENGILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 23RD ST APT 210
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-6508
Mailing Address - Country:US
Mailing Address - Phone:937-206-4724
Mailing Address - Fax:
Practice Address - Street 1:407 E LUTZ RD
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-1252
Practice Address - Country:US
Practice Address - Phone:937-206-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT017406OtherLICENSE NUMBER