Provider Demographics
NPI:1114900628
Name:DENA, REBECA MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:MICHELLE
Last Name:DENA
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 1:7050 WITMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1018
Mailing Address - Country:US
Mailing Address - Phone:716-695-0652
Mailing Address - Fax:716-695-0652
Practice Address - Street 1:7050 WITMER RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1018
Practice Address - Country:US
Practice Address - Phone:716-695-0652
Practice Address - Fax:716-695-0652
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist