Healthcare Provider Details

I. General information

NPI: 1902141724
Provider Name (Legal Business Name): RACHEL RATKE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 WILLOW OAKS CORPORATE DR STE 2120
FAIRFAX VA
22031-4511
US

IV. Provider business mailing address

8270 WILLOW OAKS CORPORATE DR STE 2120
FAIRFAX VA
22031-4511
US

V. Phone/Fax

Practice location:
  • Phone: 571-423-4864
  • Fax:
Mailing address:
  • Phone: 571-423-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: