Basic Information
| Provider Information | |||||||||
| NPI: | 1548539414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | STOCKDALE | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | BETH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3301 BERRYWOOD DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652016517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734496082 | ||||||||
| FaxNumber: | 5734490401 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E DAVIS ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652481405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602483053 | ||||||||
| FaxNumber: | 6602482682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2011 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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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 | 2010028610 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.