Healthcare Provider Details

I. General information

NPI: 1649190224
Provider Name (Legal Business Name): RACHEL MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W LINCOLN AVE
WEST ALLIS WI
53227-2409
US

IV. Provider business mailing address

7835 SANTANA CIR
INDIANAPOLIS IN
46278-2208
US

V. Phone/Fax

Practice location:
  • Phone: 414-328-6000
  • Fax:
Mailing address:
  • Phone: 317-509-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1721924
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: