Healthcare Provider Details

I. General information

NPI: 1083069256
Provider Name (Legal Business Name): RACHAEL WARREN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 D AND M CT
PEARCY AR
71964-9417
US

IV. Provider business mailing address

310 D AND M CT
PEARCY AR
71964-9417
US

V. Phone/Fax

Practice location:
  • Phone: 501-545-9888
  • Fax:
Mailing address:
  • Phone: 501-545-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8327
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: