1649723479 NPI number — RACHEL WELLMAN LOOK DPT

Table of content: RACHEL WELLMAN LOOK DPT (NPI 1649723479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649723479 NPI number — RACHEL WELLMAN LOOK DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOOK
Provider First Name:
RACHEL
Provider Middle Name:
WELLMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLMAN
Provider Other First Name:
RACHEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649723479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05468-0776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-893-7427
Provider Business Mailing Address Fax Number:
802-893-7429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 ROUTE 7 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05468-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-893-7427
Provider Business Practice Location Address Fax Number:
802-893-7429
Provider Enumeration Date:
07/28/2016

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:  040.0120852 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1028078 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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