Provider Demographics
NPI:1699931683
Name:FRANCO, RACHAEL DIANE (PT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DIANE
Last Name:FRANCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30670 PUDDING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-8109
Mailing Address - Country:US
Mailing Address - Phone:707-961-6191
Mailing Address - Fax:
Practice Address - Street 1:18661 OLD COAST HWY
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-8260
Practice Address - Country:US
Practice Address - Phone:707-961-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8418225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant