Provider Demographics
NPI:1083585269
Name:PETERSON, RACHEL MELISSA
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MELISSA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 NW 39TH PL STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8157
Mailing Address - Country:US
Mailing Address - Phone:352-275-9694
Mailing Address - Fax:844-292-3903
Practice Address - Street 1:4650 NW 39TH PL STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8157
Practice Address - Country:US
Practice Address - Phone:352-275-9694
Practice Address - Fax:844-292-3903
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist