Provider Demographics
NPI:1891202958
Name:MASSEY, RACHEL (PTA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12135 E 1750TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:IL
Mailing Address - Zip Code:62432-2315
Mailing Address - Country:US
Mailing Address - Phone:217-663-8865
Mailing Address - Fax:
Practice Address - Street 1:1111 W NORTH 12TH ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-9554
Practice Address - Country:US
Practice Address - Phone:217-774-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007897225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant