Provider Demographics
NPI:1427749381
Name:TANILLI, RACHEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:TANILLI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-9014
Mailing Address - Country:US
Mailing Address - Phone:814-664-9346
Mailing Address - Fax:
Practice Address - Street 1:6000 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1040
Practice Address - Country:US
Practice Address - Phone:814-315-3998
Practice Address - Fax:814-315-2557
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004635225100000X
PAPT031318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist