Provider Demographics
NPI:1972211779
Name:STODDARD, RACHEL JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:JEAN
Last Name:STODDARD
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 1:605 BOULEVARD PL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2712
Mailing Address - Country:US
Mailing Address - Phone:218-929-7889
Mailing Address - Fax:
Practice Address - Street 1:ST. LUKE'S HOSPITAL
Practice Address - Street 2:915 1ST STREET
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-929-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126342251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology