Provider Demographics
NPI:1548523384
Name:MIDDAY, RACHAEL (DPT, CKTP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MIDDAY
Suffix:
Gender:F
Credentials:DPT, CKTP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:NYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 52ND ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3423
Mailing Address - Country:US
Mailing Address - Phone:262-925-5000
Mailing Address - Fax:262-925-5001
Practice Address - Street 1:10222 74TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-6810
Practice Address - Country:US
Practice Address - Phone:262-925-5020
Practice Address - Fax:262-925-5021
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3022225100000X
WI11980-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13848709OtherCAQH
WI1548523384Medicaid
WI1548523384Medicaid