Provider Demographics
NPI:1053455980
Name:WALLACH, REBEKAH LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LAUREN
Last Name:WALLACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5523
Mailing Address - Country:US
Mailing Address - Phone:914-333-2403
Mailing Address - Fax:914-333-2402
Practice Address - Street 1:155 WHITE PLAINS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5523
Practice Address - Country:US
Practice Address - Phone:914-333-2403
Practice Address - Fax:914-333-2402
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist