Individual
RACHAEL THERESA DETORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
342 HAMBURG TPKE STE 202, WAYNE, NJ 07470-2166
(973) 870-0777
Mailing address
10 WYCKOFF CT, ASBURY, NJ 08802-1091
(908) 537-9794
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
25MP00878300
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/06/2016
Last updated
10/25/2024
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