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General NPI Number Information
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NPI Number | 1992298046
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Entity Type | Individual
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Provider Name | RACHELLE N SOBCZAK PTA
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 425 SUMMIT ST
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City | WILD ROSE
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State | WI
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Zip | 54984-6804
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Country | US
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Telephone | 920-662-4342
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Fax |
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Provider Business Mailing Address
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Address Line | 418 W WARREN ST
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City | NEW LONDON
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State | WI
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Zip | 54961-2030
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Country | US
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Telephone | 920-209-1935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2784
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License Number State | WI
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