Provider Demographics
NPI:1720476997
Name:SADDLEMIRE, RACHEL LYNNE (PTA)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LYNNE
Last Name:SADDLEMIRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:SADDLEMIRE
Other - Last Name:SADDLEMIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1110 COOK RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2945
Mailing Address - Country:US
Mailing Address - Phone:336-970-1386
Mailing Address - Fax:
Practice Address - Street 1:3895 OLD VINEYARD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4809
Practice Address - Country:US
Practice Address - Phone:336-970-1486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4460208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation