Provider Demographics
NPI:1992019541
Name:MULCH, RACHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MULCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:9901 N KNOXVILLE AVE
Practice Address - Street 2:STE. D
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1429
Practice Address - Country:US
Practice Address - Phone:309-243-1989
Practice Address - Fax:309-243-8168
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-017857OtherPT LICENSE