Provider Demographics
NPI:1124718788
Name:VLECK, RACHEL RUTH (MA60142087)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:RUTH
Last Name:VLECK
Suffix:
Gender:F
Credentials:MA60142087
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0287
Mailing Address - Country:US
Mailing Address - Phone:509-590-6608
Mailing Address - Fax:
Practice Address - Street 1:12121 E BROADWAY AVE
Practice Address - Street 2:ST 5B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-921-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60142087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist