Provider Demographics
NPI:1104023738
Name:VEREEN, REBECCA FOWLER (PT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:FOWLER
Last Name:VEREEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:148 SAULS ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2677
Mailing Address - Country:US
Mailing Address - Phone:843-374-0185
Mailing Address - Fax:843-374-0189
Practice Address - Street 1:3080 HIGHWAY 15-401 E STE B
Practice Address - Street 2:
Practice Address - City:MC COLL
Practice Address - State:SC
Practice Address - Zip Code:29570-6128
Practice Address - Country:US
Practice Address - Phone:843-894-1141
Practice Address - Fax:843-894-1142
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist