Provider Demographics
NPI:1093004137
Name:BUCALA, REBECCA L (PT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:BUCALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5700
Mailing Address - Street 2:VALLEY MEDICA GROUP, P.C.
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:GREENFIELD HEALTH CENTER
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1521
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:413-772-6390
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9315709OtherAETNA/US HEALTHCARE
MA93592801OtherNETWORK HEALTH PLAN
MA110088469AMedicaid
MA002117001Medicare PIN