Provider Demographics
NPI:1083044978
Name:REBUCK, KRISTA (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:REBUCK
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:RUBINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1066 FERNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-8229
Mailing Address - Country:US
Mailing Address - Phone:215-860-9393
Mailing Address - Fax:
Practice Address - Street 1:417 GROW AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-1105
Practice Address - Country:US
Practice Address - Phone:570-278-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01524400225100000X
PAPT023076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist