Healthcare Provider Details

I. General information

NPI: 1346202611
Provider Name (Legal Business Name): RACHEL ANDIE SIMON PROULX MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 RURAL RETREAT CT
ORLANDO FL
32819-3917
US

IV. Provider business mailing address

8003 RURAL RETREAT CT
ORLANDO FL
32819-3917
US

V. Phone/Fax

Practice location:
  • Phone: 407-234-2301
  • Fax: 407-264-9724
Mailing address:
  • Phone: 407-234-2301
  • Fax: 407-264-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT17836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: