Healthcare Provider Details

I. General information

NPI: 1285209775
Provider Name (Legal Business Name): RACHEL RUBY HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 PERIMETER DR # MS 4264
MOSCOW ID
83844-9803
US

IV. Provider business mailing address

411 N ALMON ST SPC 204
MOSCOW ID
83843-9714
US

V. Phone/Fax

Practice location:
  • Phone: 208-885-1673
  • Fax:
Mailing address:
  • Phone: 208-512-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: