1811306079 NPI number — DR. RACHEL KEI ROSSETTO P.T., D.P.T.

Table of content: DR. RACHEL KEI ROSSETTO P.T., D.P.T. (NPI 1811306079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811306079 NPI number — DR. RACHEL KEI ROSSETTO P.T., D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSSETTO
Provider First Name:
RACHEL
Provider Middle Name:
KEI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NISHIMOTO
Provider Other First Name:
RACHEL
Provider Other Middle Name:
KEI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T., D.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811306079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10470 OLD PLACERVILLE RD
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95827-2539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-470-0071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
568 N SUNRISE AVE
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-3097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-865-1100
Provider Business Practice Location Address Fax Number:
916-865-1105
Provider Enumeration Date:
08/12/2014

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:  41066 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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