Provider Demographics
NPI:1992298046
Name:SOBCZAK, RACHELLE N (PTA)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:N
Last Name:SOBCZAK
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 1:418 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-2030
Mailing Address - Country:US
Mailing Address - Phone:920-209-1935
Mailing Address - Fax:
Practice Address - Street 1:425 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WILD ROSE
Practice Address - State:WI
Practice Address - Zip Code:54984-6804
Practice Address - Country:US
Practice Address - Phone:920-662-4342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2784225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant