Healthcare Provider Details

I. General information

NPI: 1417723917
Provider Name (Legal Business Name): RACHEL ANDERSON PT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH CAROLINA STATE UNIVERSITY
RALEIGH NC
27695-0001
US

IV. Provider business mailing address

3120 N WALNUT CREEK PKWY APT N
RALEIGH NC
27606-3692
US

V. Phone/Fax

Practice location:
  • Phone: 919-515-2011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberP21696
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: