Provider Demographics
NPI:1295343093
Name:CONDREY, RACHAEL BLOCK (DPT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:BLOCK
Last Name:CONDREY
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 1:11801 CARTERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-3049
Mailing Address - Country:US
Mailing Address - Phone:804-921-5291
Mailing Address - Fax:
Practice Address - Street 1:2925 POLO PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-1453
Practice Address - Country:US
Practice Address - Phone:804-794-7587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist