Healthcare Provider Details

I. General information

NPI: 1528998499
Provider Name (Legal Business Name): RACHEL JOHNSON MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CORPORATE CIR
ALBANY NY
12203-5176
US

IV. Provider business mailing address

505 GOODE ST
BALLSTON SPA NY
12020-3409
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-4466
  • Fax:
Mailing address:
  • Phone: 518-879-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2039156261
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2039040261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: