Provider Demographics
NPI:1114271913
Name:BRYANT, REBEKAH KAYE (PTA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:KAYE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5109
Mailing Address - Country:US
Mailing Address - Phone:919-946-1670
Mailing Address - Fax:
Practice Address - Street 1:1407 S LAKE PARK AVE
Practice Address - Street 2:UNIT A
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6635
Practice Address - Country:US
Practice Address - Phone:219-947-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004480A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant