Basic Information
| Provider Information | |||||||||
| NPI: | 1295346187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEDTKE | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 790 | ||||||||
| Address2: | |||||||||
| City: | THERMOPOLIS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824430790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078642146 | ||||||||
| FaxNumber: | 3078642857 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 SOUTH 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | BASIN | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075689399 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2020 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1984 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.