Healthcare Provider Details

I. General information

NPI: 1629597539
Provider Name (Legal Business Name): RACHEL IAQUANIELLO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CLEVELAND ST STE 220
TAMPA FL
33606-1812
US

IV. Provider business mailing address

3903 NORTHDALE BLVD STE 111W
TAMPA FL
33624-1853
US

V. Phone/Fax

Practice location:
  • Phone: 813-805-8105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33011
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: