Provider Demographics
NPI:1669207114
Name:SULLIVAN, RACHEL CAROLINE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:CAROLINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:CAROLINE
Other - Last Name:BREITENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1645 FOREST HILL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1697
Mailing Address - Country:US
Mailing Address - Phone:478-960-7077
Mailing Address - Fax:478-245-9079
Practice Address - Street 1:1645 FOREST HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1697
Practice Address - Country:US
Practice Address - Phone:478-960-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist