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NPI Code Detail

MEDICARE: RACHAEL MARIE EWALD PT, DPT, ATC

MEDICARE:   RACHAEL MARIE EWALD  PT, DPT, 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
12255A2300XAthletic Trainer246939WI
2225100000XPhysical Therapist1362036TX

General Provider Information

NPI Number : 1942907746
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHAEL MARIE EWALD PT, DPT, ATC
Provider Business Mailing Address
First Line : 2825 BELLEFONTAINE ST APT 311A
Second Line :
City : HOUSTON
State : TX
Zip : 77025-1651
Country : US
Telephone Number : 310-283-7839
Fax Number :
Provider Business Practice Location Address
First Line : 5505 WEST LOOP S
Second Line :
City : HOUSTON
State : TX
Zip : 77081-2206
Country : US
Telephone Number : 713-441-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2023
Last Update Date : 02/13/2023

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Directions to “ RACHAEL MARIE EWALD PT, DPT, ATC” Practice Location

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