Provider Demographics
NPI:1538575014
Name:HARGROVE, RACHEL (LMT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CITY PARK AVE
Mailing Address - Street 2:APT E523
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3463
Mailing Address - Country:US
Mailing Address - Phone:719-469-9568
Mailing Address - Fax:
Practice Address - Street 1:2627 REDWING RD
Practice Address - Street 2:SUITE 350
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6321
Practice Address - Country:US
Practice Address - Phone:970-673-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012081225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist