Provider Demographics
NPI:1649602467
Name:SMITH, RACHAEL MASNER (PT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MASNER
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ANNE
Other - Last Name:MASNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:510 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3731
Mailing Address - Country:US
Mailing Address - Phone:406-222-0672
Mailing Address - Fax:
Practice Address - Street 1:510 S 14TH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3731
Practice Address - Country:US
Practice Address - Phone:406-222-0672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5890225100000X
TX1205596225100000X
WA00008922225100000X
TN0000005476225100000X
2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics