Provider Demographics
NPI:1003404955
Name:HARTNETT, REBECCA ANN (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:HARTNETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:KOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2244 SOUTHGATE SQ
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1230
Mailing Address - Country:US
Mailing Address - Phone:571-218-5192
Mailing Address - Fax:
Practice Address - Street 1:4700 STONECROFT BLVD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1716
Practice Address - Country:US
Practice Address - Phone:703-488-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260001562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer