Healthcare Provider Details

I. General information

NPI: 1689910051
Provider Name (Legal Business Name): RACHEL CLOUD P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ACTIVEWAY
BENTON AR
72019
US

IV. Provider business mailing address

1408 STAMFORD DR
BENTON AR
72019-1614
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-0984
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2493
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: