Provider Demographics
NPI:1306503818
Name:PETERSON, RACHEL (CERTIFIED MASSAGE)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CERTIFIED MASSAGE
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERTIFIED MASSAGE
Mailing Address - Street 1:735 OLYMPUS ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1836
Mailing Address - Country:US
Mailing Address - Phone:760-473-9412
Mailing Address - Fax:
Practice Address - Street 1:9700 N TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1102
Practice Address - Country:US
Practice Address - Phone:866-451-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist