Basic Information
| Provider Information | |||||||||
| NPI: | 1114144557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEARS | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EINERSON | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | LEE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 105 S JEFFERSON ST | ||||||||
| Address2: | SUITE B5 | ||||||||
| City: | KEARNEY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640608503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169030775 | ||||||||
| FaxNumber: | 8169030776 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 S JEFFERSON ST | ||||||||
| Address2: | SUITE B5 | ||||||||
| City: | KEARNEY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640608503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169030775 | ||||||||
| FaxNumber: | 8169030776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2007021000 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 38954024 | 01 | MO | BCBS | OTHER | 38954014 | 01 | MO | BCBS | OTHER |