MEDICARE: RACHEL D LETHORN PA-C, ATC

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	2255A2300X	Athletic Trainer
2	363A00000X	Physician Assistant	5601003608	MI

General Provider Information

NPI Number	:	1285601518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL D LETHORN PA-C, ATC

Provider Business Mailing Address
First Line	:	5275 TIMBER BEND DR
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-7797
Country	:	US
Telephone Number	:	248-880-8815
Fax Number	:	810-202-1044

Provider Business Practice Location Address
First Line	:	10381 CITATION DR STE 250
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-6528
Country	:	US
Telephone Number	:	810-626-3036
Fax Number	:	810-202-1044

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	04/09/2018

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