Provider Demographics
NPI:1013554625
Name:TOWNSEND, REBECCA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4421
Mailing Address - Country:US
Mailing Address - Phone:317-509-0939
Mailing Address - Fax:
Practice Address - Street 1:970 FORT WAYNE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4328
Practice Address - Country:US
Practice Address - Phone:317-509-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21505558225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist