Healthcare Provider Details

I. General information

NPI: 1417063348
Provider Name (Legal Business Name): RACHAEL MARTIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHAEL HARRISON

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/23/2020
Certification Date: 02/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 OVESON DR
WILTON IA
52778-9612
US

IV. Provider business mailing address

3196 155TH ST
MUSCATINE IA
52761-9736
US

V. Phone/Fax

Practice location:
  • Phone: 563-732-4317
  • Fax: 563-732-4318
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03364
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number03364
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number03364
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: