1811128895 NPI number — MRS. RACHEL L LONG PHYSICAL THERAPIST

Table of content: MRS. RACHEL L LONG PHYSICAL THERAPIST (NPI 1811128895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811128895 NPI number — MRS. RACHEL L LONG PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
RACHEL
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KINSUGAR
Provider Other First Name:
RACHEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811128895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
NORTH CHARLEROI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-483-3610
Provider Business Mailing Address Fax Number:
724-489-4758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 GREENFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-422-7022
Provider Business Practice Location Address Fax Number:
724-483-0519
Provider Enumeration Date:
08/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT019937 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT019937 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023295260001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".