Provider Demographics
NPI:1023067253
Name:JANSON, RACHEL JEANVIEVE (MPT)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:JEANVIEVE
Last Name:JANSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:JEANVIEVE
Other - Last Name:ASHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6630 S MCCARRAN BLVD STE A4
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6136
Mailing Address - Country:US
Mailing Address - Phone:775-828-2873
Mailing Address - Fax:775-448-9405
Practice Address - Street 1:6630 S MCCARRAN BLVD STE A4
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6136
Practice Address - Country:US
Practice Address - Phone:775-828-2873
Practice Address - Fax:775-448-9405
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1604174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV36227Medicare ID - Type Unspecified