Basic Information
| Provider Information | |||||||||
| NPI: | 1154601169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARGEANT | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PSC 819 BOX 4597 | ||||||||
| Address2: | |||||||||
| City: | FPO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09645 | ||||||||
| CountryCode: | ES | ||||||||
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| Practice Location | |||||||||
| Address1: | 411 E ORANGE ST | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338015054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636179400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2011 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT3555 | ME | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT30176 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT30176 | 01 | FL | FLORIDA DOH LICENSE | OTHER | PT3555 | 01 | ME | PHYSICAL THERAPY LICENSE | OTHER |