Healthcare Provider Details

I. General information

NPI: 1033035795
Provider Name (Legal Business Name): RACHEL DATTILO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SILVERMINE RD STE 300
BROOKFIELD CT
06804-2047
US

IV. Provider business mailing address

1322 CHRISTY AVE APT 1
LOUISVILLE KY
40204-2039
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-0855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03475
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: