Healthcare Provider Details

I. General information

NPI: 1538430145
Provider Name (Legal Business Name): RACHEL ANNE OKONSKI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 VIA CALLEJON SUITE B
SAN CLEMENTE CA
92673-6213
US

IV. Provider business mailing address

1120 VIA CALLEJON SUITE B
SAN CLEMENTE CA
92673-6213
US

V. Phone/Fax

Practice location:
  • Phone: 949-498-5100
  • Fax:
Mailing address:
  • Phone: 949-498-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: