Healthcare Provider Details

I. General information

NPI: 1184991937
Provider Name (Legal Business Name): RACHEL PLOOR M.S., ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 HERTY DRIVE HANNER FIELD HOUSE ROOM 1216
STATEBORO GA
30458
US

IV. Provider business mailing address

PO BOX 8082
STATESBORO GA
30460-1000
US

V. Phone/Fax

Practice location:
  • Phone: 912-536-3155
  • Fax:
Mailing address:
  • Phone: 912-478-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 525
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002350
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: