Provider Demographics
NPI:1023487089
Name:DEAN, RACHEL (ATC)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LEGACY PLAZA EAST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-5268
Mailing Address - Country:US
Mailing Address - Phone:219-326-2663
Mailing Address - Fax:
Practice Address - Street 1:1 REDSKIN TRL
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-2238
Practice Address - Country:US
Practice Address - Phone:574-772-1670
Practice Address - Fax:574-772-1681
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 33262255A2300X
IN36002658A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer