Provider Demographics
NPI:1538246145
Name:COFFEY, RACHAEL MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARIE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:MARIE
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1485 N TURQUOISE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2000
Mailing Address - Country:US
Mailing Address - Phone:928-774-6626
Mailing Address - Fax:928-214-3277
Practice Address - Street 1:2000 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-8759
Practice Address - Country:US
Practice Address - Phone:928-226-6402
Practice Address - Fax:928-226-6407
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007856225100000X
AZ7856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ118707Medicare PIN