MEDICARE: MRS. RACHEL KATHLEEN DRAKE 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	5517-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477564649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL KATHLEEN DRAKE PT

Provider Business Mailing Address
First Line	:	PO BOX 19070
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54307-9070
Country	:	US
Telephone Number	:	920-496-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	419-1 S WASHINGTON ST
Second Line	:
City	:	COMBINED LOCKS
State	:	WI
Zip	:	54113-1049
Country	:	US
Telephone Number	:	920-423-4192
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	02/14/2023

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