Provider Demographics
NPI:1114124039
Name:SHOOP, REBEKAH S (PT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:S
Last Name:SHOOP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 E. 56TH STREET SUITE 120
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216
Mailing Address - Country:US
Mailing Address - Phone:317-377-6400
Mailing Address - Fax:
Practice Address - Street 1:8315 E 56TH ST STE 120
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1023
Practice Address - Country:US
Practice Address - Phone:317-377-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99027644A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN156529Medicare ID - Type Unspecified