MEDICARE: MRS. RACHEL MICHELLE CRISS MHS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT18976	FL

General Provider Information

NPI Number	:	1144376625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL MICHELLE CRISS MHS PT

Provider Business Mailing Address
First Line	:	6105 NW 34TH TERRACE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32653
Country	:	US
Telephone Number	:	352-372-1960
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 NEWBERRY ROAD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607
Country	:	US
Telephone Number	:	352-373-2116
Fax Number	:	352-373-1507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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