Provider Demographics
NPI:1033690896
Name:REBIDUE, CHRISTA JULIENNE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:JULIENNE
Last Name:REBIDUE
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 1:13 GOVER RD
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-4113
Mailing Address - Country:US
Mailing Address - Phone:774-287-9987
Mailing Address - Fax:
Practice Address - Street 1:13 GOVER RD
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-4113
Practice Address - Country:US
Practice Address - Phone:774-287-9987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist