Provider Demographics
NPI:1578437604
Name:SOUTHARD, RACHEL MARIE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:SOUTHARD
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 1:10400 LANCASTER NEWARK RD NE # SR37
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046-8003
Mailing Address - Country:US
Mailing Address - Phone:740-467-2486
Mailing Address - Fax:740-467-2498
Practice Address - Street 1:10400 LANCASTER NEWARK RD NE # SR37
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046-8003
Practice Address - Country:US
Practice Address - Phone:740-467-2486
Practice Address - Fax:740-467-2498
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.027484225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist