MEDICARE: MS. RACHEL DIZON MIGUEL P.T.

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	225100000X	Physical Therapist	70009050	IL

General Provider Information

NPI Number	:	1851425854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL DIZON MIGUEL P.T.

Provider Business Mailing Address
First Line	:	319 W NORTHWEST ST
Second Line	:
City	:	WEST LEBANON
State	:	IN
Zip	:	47991-8048
Country	:	US
Telephone Number	:	217-784-8033
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 N SANGAMON AVE
Second Line	:
City	:	GIBSON CITY
State	:	IL
Zip	:	60936-1342
Country	:	US
Telephone Number	:	217-784-8033
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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