Provider Demographics
NPI:1316143738
Name:SCHMUCKER, RACHEL LEE (PTA)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LEE
Last Name:SCHMUCKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20644 RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-8946
Mailing Address - Country:US
Mailing Address - Phone:574-596-9157
Mailing Address - Fax:
Practice Address - Street 1:770 N 075 E
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-9359
Practice Address - Country:US
Practice Address - Phone:260-463-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003376A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant