1114231289 NPI number — MRS. RACHEL QUASHNOC DOLAN PT, DPT

Table of content: MRS. RACHEL QUASHNOC DOLAN PT, DPT (NPI 1114231289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114231289 NPI number — MRS. RACHEL QUASHNOC DOLAN PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLAN
Provider First Name:
RACHEL
Provider Middle Name:
QUASHNOC
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUASHNOC
Provider Other First Name:
RACHEL
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114231289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 ELMWOOD AVE.
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-271-0761
Provider Business Mailing Address Fax Number:
585-442-3143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 ELMWOOD AVE.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-271-0761
Provider Business Practice Location Address Fax Number:
585-442-3142
Provider Enumeration Date:
08/02/2010

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:  032866-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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