Healthcare Provider Details

I. General information

NPI: 1023487089
Provider Name (Legal Business Name): RACHEL DEAN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 REDSKIN TRL
KNOX IN
46534-2238
US

IV. Provider business mailing address

600 LEGACY PLAZA EAST
LA PORTE IN
46350-5268
US

V. Phone/Fax

Practice location:
  • Phone: 574-772-1670
  • Fax: 574-772-1681
Mailing address:
  • Phone: 219-326-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 3326
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002658A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: