Healthcare Provider Details

I. General information

NPI: 1699477406
Provider Name (Legal Business Name): RACHEL ODESSA WILCOX PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

2086 TUCSON AVE UNIT 1
JB ANDREWS MD
20762-5654
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-5592
  • Fax:
Mailing address:
  • Phone: 951-235-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT210002127
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: