=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366980229
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHELLE RAMOS PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2017
-----------------------------------------------------
Last Update Date | 11/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 CADLONI LN G
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94591-8437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-370-6615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 HEARTFORD WAY
-----------------------------------------------------
City | AMERICAN CANYON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94503-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-370-6615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 43576
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------