1659714061 NPI number — RACHEL ANNE CRADDOCK MED, LAT, ATC

Table of content: ALEX MAURICIO SANCHEZ (NPI 1588479315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659714061 NPI number — RACHEL ANNE CRADDOCK MED, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRADDOCK
Provider First Name:
RACHEL
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659714061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 RAVENSHILL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32724-7737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-649-7255
Provider Business Mailing Address Fax Number:
386-822-7809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 N WOODLAND BLVD
Provider Second Line Business Practice Location Address:
UNIT 8317
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32723-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-822-7152
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2013

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: 2255A2300X , with the licence number:  AL 2843 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com