Provider Demographics
NPI:1457623274
Name:ALT, RACHEL DINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:DINA
Last Name:ALT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:DINA
Other - Last Name:LACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1570 45TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1628
Mailing Address - Country:US
Mailing Address - Phone:718-436-5083
Mailing Address - Fax:
Practice Address - Street 1:1570 45TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1628
Practice Address - Country:US
Practice Address - Phone:718-436-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015465-1225100000X, 2251C2600X, 2251G0304X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics