Provider Demographics
NPI:1093899502
Name:MCFADDEN, REBECCA ANNE (MPT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANNE
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7523
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-7523
Mailing Address - Country:US
Mailing Address - Phone:530-581-3813
Mailing Address - Fax:
Practice Address - Street 1:10587 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8909
Practice Address - Country:US
Practice Address - Phone:775-324-5371
Practice Address - Fax:775-852-5373
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06882251P0200X
CA164142251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXPT000400Medicaid