Provider Demographics
NPI:1023400702
Name:RACINE, REBECCA CHEATHAM (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CHEATHAM
Last Name:RACINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4663 SANDY 16.65 LN
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9768
Mailing Address - Country:US
Mailing Address - Phone:906-789-0964
Mailing Address - Fax:
Practice Address - Street 1:4663 SANDY 16.65 LN
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-9768
Practice Address - Country:US
Practice Address - Phone:906-789-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist