Provider Demographics
NPI:1841444957
Name:DOMBART, RACHAEL NOELLE (PT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NOELLE
Last Name:DOMBART
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 1:4660 LAWRENCEVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2609
Mailing Address - Country:US
Mailing Address - Phone:678-821-2810
Mailing Address - Fax:678-894-0342
Practice Address - Street 1:4660 LAWRENCEVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2609
Practice Address - Country:US
Practice Address - Phone:678-821-2810
Practice Address - Fax:678-984-0342
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist