Healthcare Provider Details

I. General information

NPI: 1336620988
Provider Name (Legal Business Name): RACHEL LIGHTFOOT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7804
US

IV. Provider business mailing address

4125 BRIARGATE PKWY
COLORADO SPRINGS CO
80920-7804
US

V. Phone/Fax

Practice location:
  • Phone: 719-305-5134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: