Healthcare Provider Details

I. General information

NPI: 1578248472
Provider Name (Legal Business Name): RACHAEL L VACCARO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 CHAMPION DR STE 100
STATE COLLEGE PA
16803-3711
US

IV. Provider business mailing address

177 CHAMPION DR STE 100
STATE COLLEGE PA
16803-3711
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-3485
  • Fax: 814-692-2272
Mailing address:
  • Phone: 814-238-3485
  • Fax: 814-692-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberTPT023644
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: