Provider Demographics
NPI:1679393268
Name:PETERSON, RACHAEL (CMT 97120)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CMT 97120
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 K ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4921
Mailing Address - Country:US
Mailing Address - Phone:279-201-8232
Mailing Address - Fax:
Practice Address - Street 1:2110 K ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4921
Practice Address - Country:US
Practice Address - Phone:279-201-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97120225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty