Provider Demographics
NPI:1548351638
Name:FEY LARSEN, RACHEL (PT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FEY LARSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:123 W FAIR OAKS PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3708
Mailing Address - Country:US
Mailing Address - Phone:210-820-0818
Mailing Address - Fax:
Practice Address - Street 1:1901 BABCOCK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4554
Practice Address - Country:US
Practice Address - Phone:210-342-5300
Practice Address - Fax:210-342-5325
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1092625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0615Medicare ID - Type Unspecified