Provider Demographics
NPI:1619183266
Name:WOLGEMUTH, RACHEL E (PT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:WOLGEMUTH
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 1:225 PROUTY HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST ARLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05252-9712
Mailing Address - Country:US
Mailing Address - Phone:802-375-9466
Mailing Address - Fax:
Practice Address - Street 1:160 BENMONT AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1873
Practice Address - Country:US
Practice Address - Phone:802-442-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist