Provider Demographics
NPI:1952336224
Name:WEIS, RACHELLE MAY (PT)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:MAY
Last Name:WEIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 VALLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4173
Mailing Address - Country:US
Mailing Address - Phone:502-386-3198
Mailing Address - Fax:
Practice Address - Street 1:3 AUDUBON PLAZA DR STE L12
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-635-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000673699OtherANTHEM- NORTON NEUROSURGICAL INSTITUTE OF KENTUCKY