Provider Demographics
NPI:1588161251
Name:WATKINS, RACHAEL RENEE
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:RENEE
Last Name:WATKINS
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 1:10131 DWIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1035
Mailing Address - Country:US
Mailing Address - Phone:703-656-6080
Mailing Address - Fax:
Practice Address - Street 1:10131 DWIGHT AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1035
Practice Address - Country:US
Practice Address - Phone:703-656-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2020-05-20
Deactivation Date:2019-07-09
Deactivation Code:
Reactivation Date:2020-05-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer