Provider Demographics
NPI:1194565812
Name:LANZALOTTI, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LANZALOTTI
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 1:590 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2418
Mailing Address - Country:US
Mailing Address - Phone:856-472-8056
Mailing Address - Fax:
Practice Address - Street 1:718 ROUTE 113 STE B
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1022
Practice Address - Country:US
Practice Address - Phone:215-721-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019947225X00000X
NJ46TR01176200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist