MEDICARE: RACHEL JEAN LAHMAN PTA

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	225200000X	Physical Therapy Assistant	5502002461	MI

General Provider Information

NPI Number	:	1164179453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL JEAN LAHMAN PTA

Provider Business Mailing Address
First Line	:	19923 GALLAHAD DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-1756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26105 ORCHARD LAKE RD STE 311
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4510
Country	:	US
Telephone Number	:	248-615-0852
Fax Number	:

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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