MEDICARE: MARCHELLE JE-ANN RACHEL PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	PT18758	FL
2	222Q00000X	Developmental Therapist	PT18758	FL
3	225100000X	Physical Therapist	PT18758	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	Y911W	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306812375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCHELLE JE-ANN RACHEL PT, DPT

Provider Business Mailing Address
First Line	:	2038 HAWKS VIEW DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-8011
Country	:	US
Telephone Number	:	754-234-5319
Fax Number	:

Provider Business Practice Location Address
First Line	:	2038 HAWKS VIEW DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-8011
Country	:	US
Telephone Number	:	754-234-5319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	05/09/2025

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