Provider Demographics
NPI:1962066787
Name:BROWN, RACHAEL DURHAM (DPT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DURHAM
Last Name:BROWN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ALEXANDRA
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1495 RIDGEVIEW DR STE 120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-6315
Mailing Address - Country:US
Mailing Address - Phone:775-354-6143
Mailing Address - Fax:775-205-8024
Practice Address - Street 1:1495 RIDGEVIEW DR STE 120
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-6315
Practice Address - Country:US
Practice Address - Phone:775-354-6143
Practice Address - Fax:775-205-8024
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024385225100000X
NV4855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist