Provider Demographics
NPI:1780924134
Name:CARRICO, RACHEL (DPT)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:CARRICO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:627 E MAPLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2812
Mailing Address - Country:US
Mailing Address - Phone:248-524-1912
Mailing Address - Fax:
Practice Address - Street 1:627 E MAPLE RD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2812
Practice Address - Country:US
Practice Address - Phone:248-524-1912
Practice Address - Fax:248-524-3901
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist