Provider Demographics
NPI:1720692858
Name:WETZEL, RACHAEL (LMT, CPMT, CBMT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:WETZEL
Suffix:
Gender:F
Credentials:LMT, CPMT, CBMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5007
Mailing Address - Country:US
Mailing Address - Phone:073-650-7373
Mailing Address - Fax:
Practice Address - Street 1:1807 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5007
Practice Address - Country:US
Practice Address - Phone:307-365-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOL-20-37127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist