Provider Demographics
NPI:1750580924
Name:DEAN, RACHELLE DIONNE (DPT)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:DIONNE
Last Name:DEAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 THOMSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1422
Mailing Address - Country:US
Mailing Address - Phone:434-845-9054
Mailing Address - Fax:434-528-2788
Practice Address - Street 1:1948 THOMSON DRIVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1422
Practice Address - Country:US
Practice Address - Phone:434-845-9054
Practice Address - Fax:434-528-2788
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00423133OtherMEDICARE RAILROAD
VA014327R95Medicare PIN