Provider Demographics
NPI:1811307424
Name:ALLEN, RACHEL L (LMT, CMA)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT, CMA
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 6738
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-6700
Mailing Address - Country:US
Mailing Address - Phone:970-368-6936
Mailing Address - Fax:
Practice Address - Street 1:40 GLEN COVE DRIVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-6700
Practice Address - Country:US
Practice Address - Phone:970-368-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist