Provider Demographics
NPI:1174761753
Name:MENTER, RACHEL (PTA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MENTER
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 1:816 PORTER AVE
Mailing Address - Street 2:EAU CLAIRE
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3813
Mailing Address - Country:US
Mailing Address - Phone:715-832-1644
Mailing Address - Fax:715-832-1593
Practice Address - Street 1:816 PORTER AVE
Practice Address - Street 2:EAU CLAIRE
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3813
Practice Address - Country:US
Practice Address - Phone:715-832-1644
Practice Address - Fax:715-832-1593
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant