Provider Demographics
NPI:1619406279
Name:SLADE, RACHEL LYNN (PT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:SLADE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:THURSTONSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:409 RUNNELS ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2529
Mailing Address - Country:US
Mailing Address - Phone:432-264-4228
Mailing Address - Fax:432-264-4210
Practice Address - Street 1:1104 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-6450
Practice Address - Country:US
Practice Address - Phone:325-236-6821
Practice Address - Fax:432-264-4210
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1286140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist