Provider Demographics
NPI:1922898394
Name:VICK, RACHEL LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYNN
Last Name:VICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:704 MARY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3225
Mailing Address - Country:US
Mailing Address - Phone:239-776-2603
Mailing Address - Fax:
Practice Address - Street 1:2378 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8048
Practice Address - Country:US
Practice Address - Phone:989-772-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005437225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant