Provider Demographics
NPI:1114365707
Name:PANOSIAN, RACHEL CORNISH (DPT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CORNISH
Last Name:PANOSIAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 MERCHANTS VIEW SQ STE 110
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3335
Mailing Address - Country:US
Mailing Address - Phone:571-248-0232
Mailing Address - Fax:
Practice Address - Street 1:5300 MERCHANTS VIEW SQ STE 110
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-3335
Practice Address - Country:US
Practice Address - Phone:571-248-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8539716-2401225100000X
COPTL.0012185225100000X
VA2305209728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist