Basic Information
| Provider Information | |||||||||
| NPI: | 1700431517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRACOFE | ||||||||
| FirstName: | RACHEL | ||||||||
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| OtherLastName: | RUCH | ||||||||
| OtherFirstName: | RACHEL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16 MAYBROOK RD STE D | ||||||||
| Address2: | |||||||||
| City: | CAMPBELL HALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109162741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456364344 | ||||||||
| FaxNumber: | 8456364355 | ||||||||
| Practice Location | |||||||||
| Address1: | 8838 US HIGHWAY 70 W STE 300 | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275204822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195507722 | ||||||||
| FaxNumber: | 9195507742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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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 | P19004 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.