Provider Demographics
NPI:1932868551
Name:LEGACY, RACHEL ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ROSE
Last Name:LEGACY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ROSE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1599 N HERMITAGE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148
Mailing Address - Country:US
Mailing Address - Phone:724-962-7920
Mailing Address - Fax:724-962-6029
Practice Address - Street 1:565 W NESHANNOCK AVE
Practice Address - Street 2:
Practice Address - City:NEW WILMNIGTON
Practice Address - State:PA
Practice Address - Zip Code:16142
Practice Address - Country:US
Practice Address - Phone:724-946-3313
Practice Address - Fax:724-946-2770
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist