MEDICARE: MRS. RACHEL G MICHAEL DPT

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	05010840A	IN

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	:	1881946853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL G MICHAEL DPT

Provider Business Mailing Address
First Line	:	4251 LAHMEYER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5676
Country	:	US
Telephone Number	:	260-432-4700
Fax Number	:	260-459-9262

Provider Business Practice Location Address
First Line	:	4251 LAHMEYER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5676
Country	:	US
Telephone Number	:	260-432-4700
Fax Number	:	260-459-9262

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

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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