Provider Demographics
NPI:1356045520
Name:SABAUGH, RACHEL (PTA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SABAUGH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32670 COVENTRY PL
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-6121
Mailing Address - Country:US
Mailing Address - Phone:586-855-9053
Mailing Address - Fax:
Practice Address - Street 1:32670 COVENTRY PL
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6121
Practice Address - Country:US
Practice Address - Phone:586-855-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005358225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant