Provider Demographics
NPI:1427297159
Name:MINNIEFIELD, RACHEL (LMT)
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:
Last Name:MINNIEFIELD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-3348
Mailing Address - Country:US
Mailing Address - Phone:716-598-8500
Mailing Address - Fax:
Practice Address - Street 1:4565 CLARK ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3911
Practice Address - Country:US
Practice Address - Phone:716-648-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist